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Prior Authorization Forms. PA Forms for Physicians. When a PA is needed for a prescription, the member will be asked to have the physician or authorized agent of the physician contact our Prior Authorization Department to answer criteria questions to determine coverage.
information is available for review if requested by CVS Caremark®, the health plan sponsor, or, if applicable, a state or federal regulatory agency. I understand that any person who
If you wish to request a Medicare Part Determination (Prior Authorization or Exception request), please see your plan’s website for the appropriate form and instructions on how to submit your request.
CVS Caremark has made submitting PAs easier and more convenient. Some automated decisions may be communicated in less than 6 seconds! We've partnered with CoverMyMeds ® and Surescripts ® , making it easy for you to access electronic prior authorization (ePA) via the ePA vendor of your choice.
Pharmacists and Medical Professionals: Electronic Prior Authorization Information. Access the latest version of this page. Count on Generics.
Please complete this form and fax it to CVS Caremark at 1-888-836-0730 to receive a DRUG SPECIFIC CRITERIA FORM for prior authorization. Once received, a DRUG SPECIFIC CRITERIA FORM will be faxed to the specific physician along with patient specific information, appropriate criteria for the request and questions that must be answered.
A CVS/Caremark prior authorization form is to be used by a medical office when requesting coverage for a CVS/Caremark plan member’s prescription. A physician will need to fill in the form with the patient’s medical information and submit it to CVS/Caremark for assessment.
The requested drug will be covered with prior authorization when the following criteria are met: • The requested drug will be used with a reduced calorie diet and increased physical activity to reduce excess body
The requested drug will be covered with prior authorization when the following criteria are met: • The patient has a diagnosis of type 2 diabetes mellitus AND • The patient has NOT been receiving a stable maintenance dose of the requested drug for at least 3 months AND
Please contact CVS/Caremark at 1-888-413-2723 with questions regarding the prior authorization process. When conditions are met, we will authorize the coverage of the medication.