HealthChoice Medicare Supplement Plans With and Without
Part D Pharmacy Prior Authorization Process
The medications listed on this
page require prior authorization. This list is not all inclusive and subject to change.
Even though these drugs are listed on the HealthChoice Medicare Formulary, prior
authorization is needed. Prior authorization is necessary when a drug:
- Has a very high cost.
- Has specific prescribing guidelines.
- Might be covered under Medicare Part B.
- Is generally used for cosmetic purposes.
Requests for prior authorization must be submitted by your physician and
approved before you fill your prescription.
To Apply for a Prior Authorization
- Have your physician’s office contact Medco toll-free at 1-800-753-2851, Monday
through Friday (7:00 a.m. - 8:00 p.m. CST). Your physician’s office will need to
have your Member ID and medication name available.
- Medco will fax a Prior Authorization Form to your physician’s office and
request that it be completed and faxed back.
- If your prior authorization is approved, it will be loaded in Medco’s
system in 24 to 48 hours and notification of the approval will be sent to
your physician’s office. You will also be notified in writing.
- If your prior authorization does not meet clinical criteria, your
physician’s office will be sent a notification of denial in 24 to 48 hours.
You will also be notified in writing.
Note: A prior authorization is
valid for one year from the date it is issued and must be renewed when it
expires.
Last Modified on: 1/23/2009 10:15:27 AM
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