CVS Caremark’s Preferred Method for Prior Authorization Requests
Our electronic prior authorization (ePA) solution provides a safety net to ensure the right information needed for a determination gets to patients' health plans as fast as possible.
Improving efficiencies without sacrificing the essentials
- 70%1 of users reported time savings
- 35%2 faster determinations than phone or fax
- HIPAA compliant and available for all plans and all medications
- No cost to providers and their staff
How it works
Three Easy steps to completing requests electronically
- Create a free account in minutes
- Verify your NPI to receive all requests initiated at your patient’s pharmacies
- Use your account to initiate, access and submit requests
Want to learn more? Join a webinar.
“I have been using this service since last year and it simply gets better and better. It has significantly reduced the paperwork burden of my office and office staff as far as prior authorizations go.
CoverMyMeds Provider
No hold times. We know PA requests are complex. That's why we have a team of experts and a variety of help resources to make requests faster and easier. LET’s GET STARTED
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No phone trees.
1 - CoverMyMeds Provider Survey, 2019
2 - Express Scripts data on file, 2019
At CVS Specialty®, our goal is to help streamline the onboarding process to get patients the medication they need as quickly as possible. We offer access to specialty medications and infusion therapies, centralized intake and benefits verification, and prior authorization assistance.
Select your specialty therapy, then download and complete the appropriate enrollment form when you send us your prescription.
Select the starting letter of the specialty therapy/condition or medication.
Select the starting letter of the specialty therapy/condition or medication.
Download our app.
Easily manage your care. Download the CVS Specialty™ Mobile App.
Updated June 02, 2022
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. In doing so, CVS/Caremark will be able to decide whether or not the requested prescription is included in the patient’s insurance plan. If you would like to view forms for a specific drug, visit the CVS/Caremark webpage, linked below.
- Fax: 1 (888) 836- 0730
- Phone: 1 (800) 294-5979
- California Prior Authorization Form
- Specific Drug Forms
How to Write
Step 1 – In “Patient Information”, provide the patient’s full name, ID number, full address, phone number, date of birth, and gender.
Step 2 – In “Prescriber Information”, provide the prescriber’s full name, full address, office phone number, office fax number, and supply a name of a contact person.
Step 3 – In “Diagnosis and Medical Information”, specify the medication, strength, frequency, expected length of therapy, quantity, and day supply. If this is a continuation therapy, specify how long the patient has been on this medication. Lastly, supply the diagnosis and diagnosis ICD code(s).
Step 4 – Next, specify the following: what condition the drug is being prescribed for, any therapeutic failure(s) (including length of therapy for each drug), contraindicated drug(s) and any adverse effects for each drug.
Step 5 – Specify whether or not the request is for a patient with one or more chronic conditions (e.g., psychiatric condition, diabetes) who is stable on the current drug(s) and who might be at high risk for a significant adverse event with a medication change. Also, mention any anticipated significant adverse events.
Step 6 – Specify whether or not the patient has a chronic condition confirmed by diagnostic testing. If so, provide diagnostic test and date.
Step 7 – Specify whether or not the patient has a clinical condition for which other alternatives are not recommended based on published guidelines or clinical literature. If so, provide documentation.
Step 8 – Specify whether or not the patient requires a specific dosage form (e.g., suspension, solution, injection). If so, provide dosage form.
Step 9 – Specify whether or not there are additional risk factors (e.g., GI risk, cardiovascular risk, age) present. If so, provide risk factors.
Step 10 – Provide any additional relevant information.
Step 11 – The prescriber must provide their signature as well as the date at the bottom of page 1.
Step 12 – On page 2, specify the type of medication requested and select yes or no in response to the questions related to each specific drug.