866-814-5506.

MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnitCVSCaremarkPriorAuthorizationFax:1-866-249-6155P: 866 -433-6041 F: 855 -865-9469 Advicare P: 866 814 5506 F: 866 249 6155 BlueChoice HealthPlan Medicaid P: 866 -902 1689 F: 800-823-5520 FFS Medicaid P:866 247 1181 F:888 -603 7696 First Choice P: 866 610 2773 F: 866 610 2775 Molina Healthcare P: 855-237-6178 F: 855-571-3011 WellCare Health Plan P: 888-588-9842 F: 866-354-8709 PA phone number: 866-814-5506. Page 15. 15. Non-specialty appeals: Prescription Claim Appeals MC 109. CVS Caremark. P.O. Box 52084. Phoenix, AZ 85072. Fax 866- ...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. The recipient of this fax may make a request to opt-out of receiving telemarketing fax transmissions from CVS Caremark. There are numerous

Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 3 of 3 The alternate drug is not in the patient’s best interest The alternate drug was tried while covered by the current or the previous health benefit plan None of the above, continue to #8 8.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.

Call 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. Mail the completed request form to: Medical Exception to Pharmacy Prior Authorization Unit 1300 East Campbell Road Richardson, TX 75081

Phone: 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 Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 3 7. Have chart notes or other documentation supporting the inadequate response, intolerable adverse reaction, or contraindication to at least three of the formulary medications, or all of the formulary alternatives if there are fewer than three?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: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 6 Simponi, Simponi Aria 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 4. Neulasta, Fulphila, Udenyca 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 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

Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4. Hepatitis C 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. Send completed form to: Case Review Unit CVS Caremark Prior Authorization Fax: 1-866-249-6155. CVS Caremark administers the prescription benefit plan for the patient identified.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. MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorization.Fax:1-866-249-6155All 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 …

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. 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. authorization, call 866-814-5506. 2 . Identifying PEBTF Members . PEBTF members’ ID cards appear as below. PEBTF members can be identified by the member prefix . OPB. Active Population . Retiree Population . 3 List of Specialty Drugs Excluded from PEBTF Medical Coverage Effective Jan. 1, 2019 . As mentioned above, CVS Specialty® …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 certainAll 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: …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).Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4 Dupixent 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 medication—Call the authorization line at 1-866-814-5506; Return to top. Dental Insurance Coverage. Dental insurance is available to eligible full-time employees, faculty members and their eligible dependents. The plan may vary by job classification and whether the position is represented and covered by a collective bargaining agreement. Dental Plans.

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 ClassIf 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.MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorization.Fax:1-866-249-6155 Phone: 866-814-5506 | Fax: 866-249-6155. MassHealth Prior Authorization Form | Standard Prior Authorization Form. Check the top of the criteria document for additional information, including program details, benefit designation, and contact information. Phone: 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 UnknownAll 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. PedmarkPhone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Taltz 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.

866-814-5506. PLAN DESIGN. Preferred brand-name medications are listed to help identify product that are clinically appropriate and cost-effective. Generics.

Specialty Medication PA Request Phone: (866) 814-5506 Nonspecialty Medication PA Request Phone: (877) 433-7643 (Medicaid), (855) 582-2022 (Exchange),

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. Register online or call 1-800-AVAILITY (1-800-282-4548). For one-on-one support from us, call Aetna at 1-866-752-7021. Then ask to talk with the Availity team. You can use our “Search by CPT code” search function on our Precertification Lists web page to find out if the code needs precertification.Prior authorization requirements for specialty drugs in the Mass General Brigham Health Plan formulary.Call 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 …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 4. Hepatitis C 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: 866-814-5506 | Fax: 866-249-6155. MassHealth Prior Authorization Form | Standard Prior Authorization Form. Check the top of the criteria document for additional information, including program details, benefit designation, and contact information. (866) 914-5806 is a Debt Collector Robocall. Listen; Transcript Transcript not available. Date Blocked October 12, 2023 Call Activity Severe Last detected 14 hours ago; Block this robocall and over 7,608,061 more …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 . Iclusig …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 6 Section A: Preferred Product 5. These are the preferred products for which coverage is provided for the treatment of the following indications: a) Rheumatoid arthritis: Enbrel, Humira, Kevzara, Orencia (SC)/Orencia Clickject, Remicade, Rinvoq,Prescribers may call 1-866-814-5506 to enroll patients in Specialty plan design. 6 PLAN DESIGN The document represents a closed formulary plan design. The medications listed on the document are covered by the plan as represented.Phone: 866-814-5506 | Fax: 866-249-6155. MassHealth Prior Authorization Form | Standard Prior Authorization Form. Check the top of the criteria document for additional information, including program details, benefit designation, and contact information. Non-specialty medications

You will continue to be covered by TeamCare for each week an employer reports a contribution on your behalf. For additional questions, contact TeamCare through your Message Center, or by calling us at 1-800-TEAMCARE (1-800-832-6227). TeamCare is proud to offer our members the most comprehensive healthcare benefits possible, thanks …Reverse phone lookup for (866) 914-5806. Find full name, address, email, and photos for owner of (866) 914-5806 with Spokeo.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Skyrizi 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. Instagram:https://instagram. nflvisanew jersey pnc bank routing numbergp urfchevs of the 40s Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page2of4 SectionA:PreferredProduct-ForPlaquePsoriasis 7 ... publix super market at lakewood walkamazon prime pmts meaning 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.You will continue to be covered by TeamCare for each week an employer reports a contribution on your behalf. For additional questions, contact TeamCare through your Message Center, or by calling us at 1-800-TEAMCARE (1-800-832-6227). TeamCare is proud to offer our members the most comprehensive healthcare benefits possible, thanks to our ... dmv south dekalb mall 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 . Lumakras is indicated for the treatment of KRAS G12C …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 4. Neulasta, Fulphila, Udenyca 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.