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0000013136 00000 n 0000008849 00000 n Prior authorization. x�bb�g`b``Ń3� ���ţ�1�� � f�_ 0000010803 00000 n |lo�i 6��32�oez��� ��y��+�Ɇg �\��| �1�5(9;p.`�y��q ������7?�m`�����(����5�6�r$���.�hq��`ހ~�w�@���pQ1v� �D� :UhQ
��N"%J")�d��LzɄ�B1UB��qPVZ(,������d�!�gVj�8gV� ��Jɼ�P*&�C ��G�P�eSV 3��=� endstream endobj startxref 0000203679 00000 n Prior Authorization Prior authorization is a routine process. startxref 0000001362 00000 n 0000093793 00000 n %%EOF Find a Participating Pharmacy Near You More than 56,000 pharmacy locations are in the TRICARE retail pharmacy network, including national chains, grocery chains and independent pharmacies. 0000009794 00000 n CareSource is not able to pay claims for services in which prior authorization is required, but not … %%EOF Below is a list of each of the three coverage management programs, with a list of medications that will need to be reviewed by Express Scripts in order for them to be covered by your plan. Services That Require Prior Authorization All services that require prior authorization from CareSource should be authorized before the service is delivered. 316 0 obj <>stream Prior Authorization Program Information . xref Medicare plan participants who have questions about prior authorization should call Express Scripts toll-free at 866-258-5819. 0000012134 00000 n THIS LIST IS SUBJECT TO CHANGE. 0000202889 00000 n Express Scripts will return your call or send you an email. �M:x�C]���6���k�W�uVm#�t���-ߺ�� 0000012490 00000 n H��W�n�8}7��#U�i�.-���h�I�@�>(���eGV�u��3�����bER���̙j|Q7������i�������r�4���d�.Ʒ٢���\U>���+r9�9IX��d>p�?N�4,M�����r8�����)��2�2܀:�x�R�Ŧ�5�$(+X�ɒ�ł2ɧ���Z¤�)@��/>�!g�6I���hC�Ki�k ��v�б��M]�ߑ %PDF-1.5 %���� Form can be faxed to : 1 (866) 684-4477 Form can be mailed to : Express Scripts, P.O. 0000001740 00000 n Current 7/1/20 . 0000203295 00000 n x�b```b``�``c`�`f@ a�ǎ�]��z&��@�I�������mQ��e+(:i\�9i^W�']װ�k���>�ʱ��3ͫJ���)��;0L2��� ?
0000282193 00000 n We use it to make sure your prescription drug is: ... Give the form to your provider to complete and send back to Express Scripts. H�\�͊�0��y��C�ZuZ����X��C��~g�҅4_���3��X� 0000013392 00000 n Manage your Express Scripts Prior Authorization Requests CoverMyMeds is the fastest and easiest way to review, complete and track PA requests. 0000350925 00000 n 0000203268 00000 n 0000364828 00000 n 0000202652 00000 n 0000012959 00000 n You can find more information at express-scripts.com . h�b```�����B ce`a���0k�#�u��9�Tt4�ңju�ũ�u���ׅ�̼+5��L*:���AL1��)A����QH@�B�Y�X�4�?�2�����" �v "`���l:�6̧Ņ:l�z ��m���-��s�(v�?�43�S��rӀ4#Я� �K22
No, Electronic Prior Authorization is fully integrated into the EHR workflow, allowing the automatic transmission of all patient and provider demographic and medication information to the correct payer, at the touch of a button, without extra work for the clinician. endstream endobj 487 0 obj <>/Size 437/Type/XRef>>stream 0000298468 00000 n 0000003036 00000 n 0000350675 00000 n
CareSource® evaluates prior authorization requests based on medical necessity, medical appropriateness and benefit limits. 0000298445 00000 n est for Prior Authorization Page 1 ion that requires prior authorization needs to complete a form are the responsibility of the plan member.
%PDF-1.5 %���� KEY [FER] - fertility medication in which there is a lifetime limit of 3 cycles of therapy per drug class when covered; available through Freedom Fertility Pharmacy (800.660.4283) [INJ] - injectable medication [PA] - Prior Authorization is required for coverage 0000094030 00000 n 0 0 0000012782 00000 n @��h ]������g#\ endstream endobj 263 0 obj <>stream Mail: Express Scripts Canada Clinical Services 5770 Hurontario Street, 10th Floor, Mississauga, ON L5R 3G5 t a guarantee of approval. 0000002050 00000 n 0000153569 00000 n Express Scripts will review the additional information provided by your doctor, and will let you and your doctor know its decision. If you are denied coverage, you will be provided with information on how to file an appeal. Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication to determine if the medication will be covered and if so, which tier will apply based on safety, efficacy, and the Once filled-in, the TRICARE prior authorization form should be signed and dated by the prescribing physician and faxed (or mailed) to TRICARE for evaluation. 0000203037 00000 n
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