866-814-5506.

Phone: 1-866-814-5506 Fax: 1-855-330-1720 www.caremark.com Page 4 of 4 I attest that this information is accurate and true, and that documentation supporting this information is available for review if requested by CVS Caremark or the benefit plan sponsor. X_____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. Kalbitor is only …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.Specialty drugs are used to treat chronic complex conditions and require special handling and close monitoring and must be obtained from CVS Specialty Pharmacy. Note: Preauthorization is required. Call CVS Specialty Pharmacy at 1-866-814-5506 (TTY:711). Pharmacy Tier IV ( Specialty generic drugs) Tier V (Specialty preferred brand drugs) 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: 1-855-330-1720 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.... 866-814-5506 FAX 866-249-6155 lpwr https://www.caremark.com/about-us/contact-us.html https://www.cvsspecialty.com/contact-us.html Free CVS/Caremark 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 : 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 . Lumakras is indicated for the treatment of KRAS G12C …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

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 ...All Plans Phone: 866-814-5506 Fax: 866-249-6155All 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 . Amvuttra (vutrisiran) is a transthyretin-directed small …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: 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. Overview .

MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorizationFax:1-866-249-6155

Specialty drugs are used to treat chronic complex conditions and require special handling and close monitoring and must be obtained from CVS Specialty Pharmacy. Note: Preauthorization is required. Call CVS Specialty Pharmacy at 1-866-814-5506 (TTY:711). Pharmacy Tier IV ( Specialty generic drugs) Tier V (Specialty preferred brand drugs)

Scam Numbers - Find out who called you. Scam-numbers.com is one of the most advanced reverse phone lookup tools in the United States. Supported by a network of thousands of users, and using the world's most advanced web technologies, Scam Numbers helps you identify potential scam, nuisance, phishing and fraud phone calls. In order to find out who …Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page2of4 SectionA:PreferredProduct-ForPlaquePsoriasis 7 ...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: 866-814-5506. ▫ Fax: 866-249-6155. Page 38. 38. Medical Specialty Drugs. • Certain medical specialty drugs require prior authorization through. CVS ...Specialty Medication PA Request Phone: (866) 814-5506 Nonspecialty Medication PA Request Phone: (877) 433-7643 (Medicaid), (855) 582-2022 (Exchange), (800) 294-5979 (Commercial) Specialty Medication PA Request Fax: (866) 249-6155 Nonspecialty Medication PA Request Fax: (866) 255-7569 (Medicaid), (855) 245-2134 (Exchange), …MemberName:{{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 3. Neupogen, Granix, Zarxio, Nivestym. 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 …Phone: 1-808-254-4414 Fax: 1-866-237-5512 www.caremark.com Page 1 of 3 Hyaluronate Products HMSA - 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. To make an appropriate …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 …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 …• For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 or fax your completed prior authorization request form (PDF) to 1-866-249-6155. For more information, call the Provider Help Line at 1-800-238-6279 (1-800-AETNA RX) (TTY: 711). *Availity is available only to U.S. providers and its territories. Important pharmacy ... Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Tavalisse 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: 1-855-330-1720 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.

Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page7of8 InitialRequest 58.Hasthepatienteverreceived(includingcurrentutilizers ...Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Drug Requests. Commercial Plans Phone: 800-294-5979 Fax: 888-836-0730 . Health Connector Plans Phone: 855-582-2022 Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page2of4 SectionA:PreferredProduct-ForPlaquePsoriasis 7 ...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 …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Tavalisse 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 …

Phone: 1-808-254-4414 Fax: 1-866-237-5512 www.caremark.com Page 3 of 7 105. Is the patient’s asthma inadequately controlled with the use of a long acting beta agonist at the optimized dose? Action Required: Attach documentation of current medications (including doses) from the medical record Yes, Continue to #106

P: 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

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, drugPhone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3. Neupogen, Granix, Zarxio, Nivestym. 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.MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorization.Fax:1-866-249-6155• For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 or fax your completed prior authorization request form (PDF) to 1-866-249-6155. For more information, call the Provider Help Line at 1-800-238-6279 (1-800-AETNA RX) (TTY: 711). *Availity is available only to U.S. providers and its territories. Important pharmacy ...PHONE 844-556-2925 Provider Enrollment & Credentialing EMAIL [email protected] FAX 617-526-1982 Provider Service PHONE 855-444-4647 Monday through Friday 8:00 …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 053122Phone: 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.Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Rinvoq 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. Overview .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?Specialty 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 ...

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 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, drugPhone: 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 certainInstagram:https://instagram. kewaunee lighthouse camerabrinks payment loginaceable level 2 assessment answersskyrim mistwatch 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. 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 and trendy style outlet franklin tnthrone room requirements rimworld (866) 814-5506 is phone number, owned by CVS SPECIALTY G. Learn what others have to say about 8668145506 or 866-814-55061-866-814-5506. Page 19. 19. ©2022 Aetna Inc. Transition Fill. Within the first 90 days of coverage. • You can receive a one-time fill for non- specialty ... dexcom g6 sensor coupon Manage your Rx and get help when you need it. Whether you’d like to refill your Rx online or need one-on-one support, we’re here to help making living with your condition a little easier. Plus, you have options – like choosing contactless delivery to your door or pickup at your local CVS Pharmacy. View transcript. Getting to Know CVS ...• Phone 866-814-5506 • Fax 866-249-6155 Preventive Dental Care Delta Dental 800-872-0500 Pediatric Dental Delta Dental 855-264-7898 Sleep Study Authorizations CareCentrix 866-827-5861 Pediatric Vision EyeMed 844-201-3993 Paper Claims In-network HMO medical claims: Payer ID: 04293 Paper Claims: PO Box 853908, Richardson, TX 75085 …Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Drug Requests. Commercial Plans Phone: 800-294-5979 Fax: 888-836-0730 . Health Connector Plans Phone: 855-582-2022