Prior authorization for pharmacy drugs

• Check the MassHealth formulary to see if a prior authorization is required for a pharmacy drug. 

• Submit requests online through an ePA portal
  • Surescripts
  • CoverMyMeds
  • ExpressPath
• To request a prior authorization form for a member, Request a Medical Exception
  • Upon receipt of your request, the PA form will be faxed to the requesting provider
  • Fax the completed prior authorization form to 833-951-1680
• Call 877-417-1822 to initiate a prior authorization by phone

• Check the formulary to see if a prior authorization is required for a pharmacy drug.
  • Specific medication criteria can be found here.
• If a prior authorization is required, submit your request:
  • Online through an ePA portal
    • Surescripts
    • CoverMyMeds
    • ExpressPath
  • Fax a prior authorization form to 833-951-1680
    • Standard Medication Prior Authorization Form
    • Chemotherapy and Supportive Care Prior Authorization Request Form
    • Hepatitis C Prior Authorization Form
    • Synagis Prior Authorization Form
  • Call 877-417-0528 to initiate a prior authorization by phone

• Check the formulary to see if a prior authorization is required for a pharmacy drug. 
  • Specific medication criteria can be found here.

• Submit requests online through an ePA portal
  • Surescripts
  • CoverMyMeds
  • ExpressPath
• To request a prior authorization form for a member, Request a Medical Exception
  • Upon receipt of your request, the PA form will be faxed to the requesting provider
  • Fax the completed prior authorization form to 833-951-1680
• Call 877-573-1929 to initiate a prior authorization by phone

• Check the formulary to see if a prior authorization is required for a pharmacy drug
• Submit requests online through an ePA portal
  • Surescripts
  • CoverMyMeds
  • ExpressPath
• To request a prior authorization form for a member
  • Online: Request a Medical Exception
  • Fax: send the completed prior authorization form to 833-951-1680
  • Upon receipt of your request, the PA form will be faxed to the requesting provider

• Call 877-417-1839 to initiate a prior authorization by phone

Community Mental Health Center Providers Only
Prior Authorization requirements for Behavioral Health Medications for CMHC providers in NH:

• CMHC Standard Prior Authorization Form
• Drug Prior Authorization Policies

• Check the formulary to see if a prior authorization is required for a pharmacy drug.
  • Specific medication criteria can be found here.

• Submit requests online through an ePA portal
  • Surescripts
  • CoverMyMeds
  • ExpressPath
• Fax a prior authorization form to 877-251-5896
• Call 877-417-1828 to initiate a prior authorization by phone