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Prior authorization (PA) Also known as a “coverage review,” this is a process health plans might use to decide if your prescribed medicine will be covered. Plans use this to help control costs and to ensure the medicine being prescribed is an effective treatment for the condition.
Phone Number: Based upon each patient’s prescription plan, additional questions may be required to complete the prior authorization process. If you have any questions about the process or required information, please contact our prior authorization team at the number listed on the top of this form.
Express Scripts’ prior authorization phone lines are open 24 hours a day, seven days a week, so a determination can be made right away. If the information provided meets your plan's requirements, you pay the plan’s copayment at the pharmacy.
Complete and Submit Your Request. Any plan member who is prescribed a medication that requires prior authorization needs to complete and submit this form. Any fees related to the completion of this form are the responsibility of the plan member. 3 Easy Steps.
Follow these simple steps in order to complete and submit a Prior Authorization form for review. 3 Easy Steps. Step 1 Patient completes Part A. Step 2 Prescribing physician completes Part B. Step 3 Fax or mail the completed form to Express Scripts Canada ®.
Please call us at 800.753.2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request. If you can't submit a request via telephone, please use our general request form or one of the state specific forms below and fax it to the number on the form.
