866-814-5506. 1-866-814-5506 (TTY: 711) or go to our . Forms for Health Care Prof...

Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of

1-866-814-5506 (TTY: 711) or go to our . Forms for Health Care Professionals . page and scroll down to the Specialty Pharmacy Precertification (Commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification request form. Alimta® (For Maryland Only) Alphanate®, Humate-P®, Koate-DVI®, Wilate®. Alphanate®, Humate-P®, Koate-DVI®, Wilate® (For Maryland Only) Alsuma®. Altoprev®. Altoprev® (For Maryland Only) Alvesco®. Alvesco® (For Maryland Only) Amerge®, Imitrex®, Maxalt®, Zomig® Post Limit. Call CVS Specialty Pharmacy Services at 866-814-5506 to obtain prior authorization. How to request precertification for an admission or get prior ...All Plans Phone: 866-814-5506 Fax: 866-249-6155 : Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 : Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 :Caremark Prescription Drug Program The Fund offers you the opportunity to purchase prescription drugs at a greatly reduced cost through Caremark (the Contract Pharmacy Network). Mail order is required for maintenance medications after TWO fills (one original fill followed by one subsequent refill) at a retail pharmacy.866-814-5506. PLAN DESIGN. Preferred brand-name medications are listed to help identify product that are clinically appropriate and cost-effective. Generics.All Plans Phone: 866 -814-5506 Fax: 866 -249-6155 : Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 : Medical Specialty Medications (NLX) All Plans Phone: 844 -345-2803 Fax: 844 -851 …41 searches. (866) 960-1091. (866) 951-9700. Did you get a call or text from 866-814-5506? View owner's full name, address, public records, and background check for +18668145506 with Whitepages reverse phone lookup.If you have questions regarding the prior authorization, please contact CVS Caremark at 1-866-814-5506. For inquiries or questions related to the patient's eligibility, drug copay or medication delivery; please contact the Specialty Customer Care Team: CaremarkConnect® 1-800-237-2767.Caremark Prescription Drug Program The Fund offers you the opportunity to purchase prescription drugs at a greatly reduced cost through Caremark (the Contract Pharmacy Network). Mail order is required for maintenance medications after TWO fills (one original fill followed by one subsequent refill) at a retail pharmacy.For MassHealth Questions about pharmacy guidelines? Call provider services at 855-444-4647. Prior authorization requirements for specialty drugs in the Mass General Brigham …All Plans Phone: 866-814-5506 Fax: 866-249-6155 . ... 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . Saphnelo (anifrolumab) is a type 1 interferon (IFN) receptor …Please respond below and fax this form to CVS Caremark toll-free at 1-866-249-6155. If you have questions regarding the prior authorization, please contact CVS Caremark at 1-866-814-5506. For inquiries or questions related to the patient’s eligibility, drug MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorization.Fax:1-866-249-6155Alimta® (For Maryland Only) Alphanate®, Humate-P®, Koate-DVI®, Wilate®. Alphanate®, Humate-P®, Koate-DVI®, Wilate® (For Maryland Only) Alsuma®. Altoprev®. Altoprev® (For Maryland Only) Alvesco®. Alvesco® (For Maryland Only) Amerge®, Imitrex®, Maxalt®, Zomig® Post Limit.1-866-814-5506. For inquiries or questions related to the patient’s eligibility, drug copay or medication delivery; please contact the Specialty Customer Care Team: CaremarkConnect All Plans Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Medications . MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 : Exceptions: …Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page4of4 SectionE:PsoriaticArthritis Continuation 30 ...All Plans Phone: 866 -814-5506 Fax: 866 -249-6155 : Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 : Medical Specialty Medications (NLX) All Plans Phone: 844 -345-2803 Fax: 844 -851 …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Palynziq Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Epogen, Procrit, Retacrit Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.For specialty drug prior authorization review, your doctorshould call CVS Caremark toll-free at 1-866-814-5506 before you go to the pharmacy. The prior authorization line is for your doctor's use only.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Revatio (sildenafil) Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.All Plans Phone: 866-814-5506 Fax: 866-249-6155 ... MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . Alli (orlistat) is for …Specialty Medication PA Request Phone: (866) 814-5506. Nonspecialty Medication PA Request Phone: (877) 433-7643 (Medicaid), (855) 582-2022 (Exchange),. (800) ...Please respond below and fax this form to CVS Caremark toll-free at 1-866-249-6155. If you have questions regarding the prior authorization, please contact CVS Caremark at 1-866-814-5506. For inquiries or questions related to the patient’s eligibility, drug Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Epogen, Procrit, Retacrit Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.7. OTHER SERVICES (SEE INSTRUCTIONS) Type of Service: Name of Therapy/Agency: 69O-161.011 OIR-B2-2180 New 12/16 CVS Caremark Specialty Prior Authorization 800 Biermann Court Mount Prospect, IL 60056 Phone 1-866-814-5506 Fax 1-866-249-6155 75-42254A 053122 Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Berinert Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered. All Plans Phone: 866-814-5506 Fax: 866-249-6155 . ... 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . Esketamine (S-enantiomer of racemic …Contact CVS/Caremark at 1-866-814-5506 for more information. If you are currently taking a drug that requires review, CVS/Caremark will work with you and your doctor to assist you …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 5 Growth Hormone Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 4 of 6 24. Does the patient meet either of the following: a) the patient was tested for the rheumatoid factor (RF) biomarker and the RF biomarker test was positive, or b) the patient was tested for the anti-cyclic citrullinated peptide (anti-CCP) Phone: 1-866-814-5506 Fax: 1-855-330-1720 www.caremark.com Page 1 of 3. Reclast. Prior Authorization Request. Send completed form to: Case Review Unit CVS Caremark Specialty Programs Fax: 1-855-330-1720. CVS Caremark administers the prescription benefit plan for the patient identified.MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnitCVSCaremarkPriorAuthorizationFax:1-866-249-61551-866-814-5506. For inquiries or questions related to the patient’s eligibility, drug copay or medication delivery; please contact the Specialty Customer Care Team: CaremarkConnectAll Plans Phone: 866-814-5506 Fax: 866-249-6155 Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . …(866) 814-5506 is phone number, owned by CVS SPECIALTY G. Learn what others have to say about 8668145506 or 866-814-5506Starting January 1, 2017, Walgreens will manage all Prime Therapeutics medications in more than 8,000 pharmacy locations.All Plans Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Medications . MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A …All Plans Phone: 866-814-5506 Fax: 866-249-6155 ... 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 : Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 : Exceptions: N/A : Overview : Cetirizine hydrochloride is a histamine-1 (H1) receptor …All Plans Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Medications . MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 .Phone: (866) 814-5506, Options 1 and 4. Fax: (866) 249-6155. FEP Plan Phone: (877) 727-3784. Council for Affordable Quality Healthcare (CAQH). Credentialing ...Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 5 Growth Hormone Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.41 searches. (866) 960-1091. (866) 951-9700. Did you get a call or text from 866-814-5506? View owner's full name, address, public records, and background check for +18668145506 with Whitepages reverse phone lookup.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 your plan's website for the appropriate form and instructions on how to submit your request. Phone: 1-877-433-7643.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 3 of 4 16. Is the requested medication being prescribed in any of the following clinical settings? Indicate below and no further questions. As a single agent In combination with telotristat for persistent diarrhea due to poorly controlled carcinoid syndromePhone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 2 10. Has the patient received clinical assessments for seizures that include all of the following? ACTION REQUIRED: If Yes, attach supporting chart note(s) or medical record. All of the following must be noted in the chart notes or reports. Yes No Unknown PPO outpatient services do not require Pre-Service Review. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Please refer to the criteria listed below for genetic testing. Contact 866-773-2884 for authorization regarding treatment.All Plans Phone: 866-814-5506 Fax: 866-249-6155 . ... 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . Bylvay (odevixibat) is indicated for the treatment of pruritis …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4 Cosentyx Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.For requests for drugs on the Aetna Specialty Drug List, call the Precertification Unit at 1-866-814-5506 (TTY: 711) or fax your completed prior authorization request form to 1-866-249-6155. These changes will affect all drug lists, precertification, quantity limits and step-therapy programs.All Plans Phone: 866-814-5506 Fax: 866-249-6155 Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . …Reverse phone lookup for (866) 914-5806. Find full name, address, email, and photos for owner of (866) 914-5806 with Spokeo.All Plans Phone: 866-814-5506 Fax: 866-249-6155 ... 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 Exceptions N/A Overview These criteria were developed to meet state-specific regulatory …1-866-814-5506 (TTY: 711) or go to our . Forms for Health Care Professionals . page and scroll down to the Specialty Pharmacy Precertification (Commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification request form. 1 Jan 2020 ... Prescribers may call 1-. 866-814-5506 to request an SGM review. Quantity Limitations. Page 7. Prescription Drug – CDHP Plan. 7. Plan Year 2020.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4 Doptelet Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.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 your plan's website for the appropriate form and instructions on how to submit your request. Phone: 1-877-433-7643.All Plans Phone: 866-814-5506 Fax: 866-249-6155 . ... 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . Prescriptions that meet the initial step therapy requirements …1-866-814-5506. • Fax the completed request form to: Non-Specialty 1-888-836-0730 or Specialty 1-866-249-6155. • Mail the completed request form to: Aetna Pharmacy Management 1300 East Campbell Road Richardson, TX 75081 Pharmacy and Therapeutics (P&T) committee The services of an independent National Pharmacy andMemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorization.Fax:1-866-249-6155Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 1. Inrebic. Prior Authorization Request . CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prio r authorization for certain medications in order for the drug to be covered.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Buphenyl, Olpruva, Pheburane [sodium phenylbutyrate] Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certainPhone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4 Doptelet Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. This patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered.Specialty® at 1-866-814-5506 to request prior authorization. The prior authorization line is for your doctor’s use only. The step therapy program encourages utilization of clinically appropriate and lowest net cost medications within the following therapeutic categories. Drug Class Medical specialty and pharmacy policies. IMPORTANT COVID-19 INFORMATION: During the COVID-19 public health emergency, some of our medical specialty and pharmacy policies may be superseded by the information on our COVID-19 FAQ. For Commercial. For MassHealth. Learn how we’re changing the world of medicine. Discover career opportunities, our product pipeline, and browse media resources. Meet Moderna.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 3 10. Does the patient have risk factors for TB (e.g., persons with close contact to people with infectious TB disease; persons who have recently immigrated from areas of the world with high rates of TB (e.g., Africa, Asia, Eastern866-750-9107 302-731-1166 800-555-0433 800-454-9078 302-731-1166 800-669-0102 904-954-7500 402-935-7733 800-830-8574 800-824-9289 602-766-6484 888-800-5234 …1-866-814-5506. • Fax the completed request form to: Non-Specialty 1-888-836-0730 or Specialty 1-866-249-6155. • Mail the completed request form to: Aetna Pharmacy Management 1300 East Campbell Road Richardson, TX 75081 Pharmacy and Therapeutics (P&T) committee The services of an independent National Pharmacy andCall the Pharmacy Precertification Unit: Non-Specialty 1-800-294-5979 (TTY: 711) or Specialty 1-866-814-5506 (TTY: 711). Fax the completed request form to: Non-Specialty 1-888-836-0730 or Specialty 1-866-249-6155 .All Plans Phone: 866-814-5506 Fax: 866-249-6155 Non-Specialty Medications : MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 . Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 . Exceptions. N/A . Overview . …For requests for drugs on the Aetna Specialty Drug List, call at 1-866-814-5506 (TTY: 711) or fax your completed prior authorization request form (PDF) to 1-866-249-6155. For more information, call the Provider Help Line at 1-800-AETNA RX (1-800-238-6279) (TTY: 711) . *Availity is available only to U.S. providers and its territories. Legal noticesPrior authorization requirements for specialty drugs in the Mass General Brigham Health Plan formulary.. All Plans Phone: 866-814-5506 Fax: 866-249-6155 . Non-SChat with your CareTeam from 8 AM to 9 PM ET to For MassHealth Questions about pharmacy guidelines? Call provider services at 855-444-4647. Prior authorization requirements for specialty drugs in the Mass General Brigham …CVS Caremark is dedicated to helping physicians manage and help their patients who are suffering from complex disorders and require specialized therapies and personalized care. 1-866-814-5506. For inquiries or questions related to the pa MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnitCVSCaremarkPriorAuthorizationFax:1-866-249-6155 Phone: 1-866-814-5506 Fax: 1-855-330-1720...

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