Cvs caremark specialty pharmacy prior authorization phone number

Careful handling and quick delivery for specialty drugs

The network specialty pharmacy fills prescriptions for specialty drugs. These types of drugs may be injected, infused or taken by mouth. Usually, you can't get these drugs at a local retail pharmacy. They often need special storage and handling, and they need to be delivered quickly.
 

• Free, secure delivery (usually within 48 hours of confirming your order)
• Delivery to your home, doctor's office or any other place you choose
• Package tracking for prompt delivery
• Training on how to self-inject your medicine
• Flexible payment options
• Free injection supplies, such as needles, syringes, alcohol swabs, adhesive bandages and containers for needle waste

How to get started

How to be sure your drugs are covered

Our specialty pharmacies is URAC accredited

See if a plan covers the medications you take most

Read more about URAC and our pharmacy accreditations

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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

1 - CoverMyMeds Provider Survey, 2019

2 - Express Scripts data on file, 2019

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.

How do I get my prior authorization from CVS Caremark?

Is CVS specialty the same as CVS Caremark?

What is Caremark specialty pharmacy?

What is CVS Caremark phone number?