Prior Authorizations

PA Requests

The prescriber may need to contact {{'COMPANY_NAME_LONG'|translate}} to discuss whether the intended use of the drug is allowable on the member's plan. A Prior Authorization may be necessary for a medication dispensed at a retail or mail order pharmacy depending on the member's plan benefit.

Claims requiring a Prior Authorization will reject with an error code of "75 — Prior Authorization Required" alerting you that additional requirements are needed to fill the requested prescription. You will need to inform the member that additional information is required from the member's prescribing doctor.

Electronic PA Requests

{{'COMPANY_NAME_SHORT'|translate}} partners with CoverMyMeds to allow for the submission of electronic PA requests. For faster coverage determinations, go to www.CoverMyMeds.health.

Fax PA Requests

The Prescription Drug Prior Authorization form may be completed by the prescriber and faxed to {{'COMPANY_NAME_LONG'|translate}} at {{'PA_AUTH_PROVIDER_FAX'|translate}}.

For drug specific forms please see the Forms tab under Resources.

Please alert the member that the above steps will take additional time to complete. If this is an urgent prescription, have the member call {{'COMPANY_NAME_SHORT'|translate}} Customer Service at {{'PA_AUTH_PROVIDER_NUMBER'|translate}}.

Plan Specific PA Requests

Evry Health

You may provide the Evry Health Prescription Drug Prior Authorization form to the member and direct the member to contact their prescribing doctor to complete the form and fax it to {{'COMPANY_NAME_LONG'|translate}} at 866-291-3727. The doctor may need to contact {{'COMPANY_NAME_LONG'|translate}} to discuss whether the intended use of the drug is allowable on the member's plan.

Please alert the member that the above steps will take additional time to get the prescription filled. If this is an urgent prescription, have the member call {{'COMPANY_NAME_SHORT'|translate}} Customer Service at 833-605-0625.

San Francisco Health Plan (SFHP)

You may provide the SFHP Prescription Drug Prior Authorization form to the member and direct the member to contact their prescribing doctor to complete the form and fax it to {{'COMPANY_NAME_LONG'|translate}} at 888-656-7789. The doctor may need to contact {{'COMPANY_NAME_LONG'|translate}} to discuss whether the intended use of the drug is allowable on the member's plan.

Please alert the member that the above steps will take additional time to get the prescription filled. If this is an urgent prescription, have the member call {{'COMPANY_NAME_SHORT'|translate}} Customer Service at 800-424-4331.

PA Medical Benefit

Obtain a Prior Authorization for a provider-administered drug covered through the medical benefit or the medical pharmacy program.