All pharmacy prior authorization (PA) requests require complete clinical documentation and medical justification. Missing clinical information will trigger outreach which will delay determinations. All pharmacy PA requests must include: Pharmacy PA Request for Medicare and Marketplace Members CVS Caremark supports management of prescription drug benefits for our Medicare and Marketplace members. PA requests for pharmacy and HCPC/JCode can be submitted to ConnectiCare by phone, fax, or Electronic Prior Authorization platforms (Marketplace only): Line of Business Contact Information Medicare Phone: 800-665-3086 Forms: References: Marketplace (on and off exchange) Phone: 888-407-6425 Forms: References: Pharmacy PA Request for Commercial Members Prime Therapeutics provides pharmacy benefit management (PBM) and medical pharmacy drug benefit management services for our commercial plan members. To request PA, providers can contact Prime directly: Line of Business Contact Information Commercial (employer group) PBM phone: 866-799-7919 References:
Part D Fax: 866-290-1309
J Code Fax: 800-391-6437
Request for Medicare Drug Coverage Determination
Request for Redetermination of Medicare Prescription Drug Denial
Medicare Formulary
Prior Authorization List
Pharmacy and JCode Fax: 833-896-0676
Online:SureScripts®andCoverMyMeds®
Pharmacy Prior Authorization
Marketplace Formulary
Pharmacy Policy Criteria
PBM online: CoverMyMeds®
Medical Pharmacy phone: 833-519-4548
Medical Pharmacy online: GatewayPA.com
Commercial Formulary
Medical Pharmacy Policies
Prior Authorization List
