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

All Plans Phone: 866-814-5506 Fax: 866-249-6155 ... 877-433-

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.Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page7of8 InitialRequest 58.Hasthepatienteverreceived(includingcurrentutilizers ...Phone 1-866-814-5506 Fax 1-866-249-6155. 75-42254A 053122. All of the applicable information and documentation is required. Incomplete forms will be returned ...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).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 notices41 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: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 3 7. Does the patient have a confirmed diagnosis of severe major depressive disorder (single or recurrent episode), documented by standardized rating scales that reliably measure depressive symptoms (e.g., Beck Depression ScaleMemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnitCVSCaremarkPriorAuthorizationFax:1-866-249-6155Phone: 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.1 Mar 2021 ... 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 ...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.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 All specialty medications require prior authorization. The process begins with a call to CVS Caremark at 1-866-814-5506. Tobacco Cessation: Tobacco cessation ...Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of NUMPAGES 3 Otezla 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 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.Chat with your CareTeam from 8 AM to 9 PM ET to ask questions about: Rx orders and refills. Billing, insurance or payments. Financial assistance. Sign in or register, then click on the chat icon. Getting Started with CVS Specialty. Supported Conditions. Learn more about how to contact CVS Specialty Pharmacy.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 …Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 2 of 3 10. To which topical therapies, if any, has the patient had an inadequate treatment response in the past 180 days? ACTION REQUIRED: If Yes, please attach supporting chart note(s) or medical record showing drug name, dosage form and strength. Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Juxtapid 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 .To check to the status of a submitted PA, call 808-254-4414 or 1-866-814-5506, Monday through Friday, 8 a.m.-5 p.m. Hawaii Standard Time. Specialty ...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 ...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.If you have questions about our prior authorization requirements, please refer to CVS Caremark at 1-866-814-5506 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 c. Units/Volume/Visits Requested: d.1-866-814-5506. 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 ...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.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 ... MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorizationFax:1-866-249-6155Phone: 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.Phone number for specialty Prior Authorization: 866-814-5506 . Fax number for non-specialty Prior Authorization: 866-255-7569 . Fax number for non-specialty Prior Authorization: 866-249-6155 . Confidentiality Notice: The documents accompanying this transmission contain confidential health information that is legally privileged.For MassHealth Questions about pharmacy guidelines? Call provider services at 855-444-4647. Prior authorization requirements for specialty drugs in the Mass General Brigham …at 866-814-5506. I received a notification from CVS/Caremark that my previous drug is not covered. What should I do? Like with the Express Scripts plan, certain medications may be subject to prior authorization, medical necessity, or step therapy. These programs require a progression of alternative 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.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.Phone: 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.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.Learn how we’re changing the world of medicine. Discover career opportunities, our product pipeline, and browse media resources. Meet Moderna.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. Cinqair, Fasenra, Nucala and Xolair solutions are Medical Benefit only . …MemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorizationFax:1-866-249-6155Specialty Guideline Management, please call 1-866-814-5506. ANALGESICS § NSAIDs diclofenac sodium delayed-rel § First Generation diclofenac sodium ext-rel diflunisal etodolac etodolac ext-rel atovaquone flurbiprofen ibuprofen cefuroxime axetil ketorolac QL ivermectin meloxicam linezolid nabumetone linezolid injection naproxen metronidazole …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.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 Targeted Product(s) Preferred Product(s) Autoimmune Physician …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 Unknown 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 . Brovana and formoterol are within the class of …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 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.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 . …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.• 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 …Specialty Medication PA Request Phone: (866) 814-5506 Nonspecialty Medication PA Request Phone: (877) 433-7643 (Medicaid), (855) 582-2022 (Exchange),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.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 . Brovana and formoterol are within the class of …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 Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 2 Xenazine (tetrabenazine) 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 . ... 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 …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 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 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. Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Neulasta and pegfilgrastim biosimilars 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 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 notices1-866-814-5506 (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. 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 …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 .To check to the status of a submitted PA, call 808-254-4414 or 1-866-814-5506, Monday through Friday, 8 a.m.-5 p.m. Hawaii Standard Time. Specialty .... All Plans Phone: 866-814-5506 Fax: 866-249-6155 . Non-Specialty Phone:1-866-814-5506 Fax:1-866-249-6155 www.caremark.com Page4of4 Starting January 1, 2017, Walgreens will manage all Prime Therapeutics medications in more than 8,000 pharmacy locations.Learn how we’re changing the world of medicine. Discover career opportunities, our product pipeline, and browse media resources. Meet Moderna. Phone: 866-814-5506 | Fax: 866-249-6155. MassHealth Prio 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. All Plans Phone: 866-814-5506 Fax: 866-249-6155 . ... 877-433-764...

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