Prior Authorization Information
Prior Authorization
Prior authorization is a review process that a member’s plan uses to make sure the medications, tests and treatments they receive are clinically appropriate, safe, and affordable.
Prior authorization can help:
- Provide coverage and potentially lower the member's medication costs.
- Ensure that members receive the right drug and quantity for the appropriate amount of time.
- Ensures a patient’s safety by reducing risk of misuse of medications that could create patient harm.
Drugs that typically require prior authorization include those that are:
- Possible to overuse, misuse or use off label
- Mostly used by a specific group of patients
- Known to have major safety concerns
- Used for conditions that aren’t included in the patient’s pharmacy benefit, such as for cosmetic reasons
- High in price
The term prior authorization may be used by the plan to also include exception reviews for quantity limitations, step therapy protocol and/or non-formulary drug coverage.
When a prior authorization is needed for a prescription, the member will be asked to have their health care provider or their provider’s authorized agent contact the CVS Caremark® Prior Authorization Department to answer criteria questions to determine coverage.
The health care provider or their authorized agent can request a prior authorization (depending on the plan) electronically (ePA) or telephone.
For more information on submitting an ePA request, please visit this page.
If you wish to submit a prior authorization request by phone, please contact the appropriate prior authorization department.
Hours: Monday through Friday 8AM–6PM CT
Contact CVS Caremark Prior Authorization Department
Medicare Part D
Submit an ePA Request: www.caremark.com/ePA
- Phone: 1-855-344-0930
- Fax: 1-855-633-7673
- If you wish to request a Medicare Part Determination (prior authorization or exception request), please see their plan’s website for the appropriate form and instructions on how to submit your request.
Medicaid
Submit an ePA Request: www.caremark.com/ePA
- Phone: 1-877-433-7643
- Fax: 1-866-255-7569
- Medicaid PA Request Form (Minnesota)
Non-Medicare
Submit an ePA Request: www.caremark.com/ePA
- Phone: 1-800-294-5979
- Fax: 1-888-836-0730
- Global Prior Authorization Form
- Non-Medicare Prior Authorization Forms
- Preventive Services Contraceptive Zero Copay Exception Form
- Preventive Services Contraceptive Zero Copay Exceptions Process
State-Specific Requirements and PA Forms
- Alaska Step Therapy Protocol Exception Process
- Arizona Appeal Information Packet
- Arizona State PA Request Form
- Arkansas Appeals Request Process
- Arkansas State PA Request Form
- Arkansas Step Therapy Protocol Exception Process
- California State PA Request Form
- Colorado Prior Authorization Request Process
- Colorado Standard Contraceptive Exceptions Form
- Colorado State PA Request Form
- Colorado Serious Mental Illness Step Therapy Exception Form
- Connecticut Step Therapy Exception Disclosure
- Delaware State PA Request Form
- Florida State PA Request Form
- Florida State PA Request Form (Specialty)
- Florida Requesting a Step Therapy Exemption
- Florida Step Therapy Exemption Form
- Illinois State PA Request Form
- Kentucky Step Therapy Exception Request Form
- Louisiana State PA Request Form
- Massachusetts Chemotherapy PA Request Form
- Massachusetts State PA Request Form
- Massachusetts Hepatitis C PA Request Form
- Massachusetts Synagis PA Request Form
- Michigan State PA Request Form
- Minnesota State PA Request Form (Commercial)
- Minnesota State PA Request Form (Exchange)
- Minnesota Step Therapy Exception Form
- Mississippi State PA Request Form
- Nebraska State PA Request Form
- Nebraska AI Disclosure
- Nevada Step Therapy Protocol Exception Process
- New Hampshire State PA Request Form
- New Jersey Step Therapy Protocol Exception Process
- New Mexico State Drug Prior Authorization Form
- Oregon State PA Request Form
- Tennessee Step Therapy Protocol Exception Process
- Texas State PA Request Form
- Washington Exception Process
- West Virginia PA Request Form