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Prior Authorization Forms
PA Forms for Physicians
When a PA is needed for a prescription, the member will be asked to have the physician or authorized agent of the physician contact our Prior Authorization Department to answer criteria questions to determine coverage.
If a form for the specific medication cannot be found, please use the Global Prior Authorization Form.
California members please use the California Global PA Form. To access other state specific forms, please click here.
For Colorado Prescribers: If additional information is required to process an urgent prior authorization request, Caremark will advise the prescribing provider of any information needed within (1) business day of receiving the request. The prescribing provider must submit the information requested within two (2) business days of receiving Caremark’s request. Otherwise, the request will be deemed denied.
An urgent request shall be deemed approved if notification of an approval or denial is not provided within 1 business day of the request or, if applicable, the receipt of any requested additional information.
If additional information is required to process a non-urgent prior authorization request, Caremark will advise the prescribing provider of any information needed within (2) business days of receiving the request. The prescribing provider must submit the information requested within two (2) business days of receiving Caremark’s request. Otherwise, the request will be deemed denied.
Non-urgent requests for prior authorization will be deemed approved if notification of an approval or denial is not provided:
- within 2 business days of receiving an electronically filed prior authorization request or, if applicable, the receipt of any requested additional information, or
- within 3 business days of receiving a prior authorization request submitted via facsimile, electronic mail, or verbally with associated written confirmation, or, if applicable, the receipt of any requested additional information.
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