Prior Authorization

How to Submit Medication Prior Authorization Requests

If you believe that it is medically necessary for a member to take a medication restricted under one of our pharmacy programs, please: 

1. Check the formulary to see if prior authorization is required for a medication.
2. If you believe that it is medically necessary for a member to take a medication that is not covered by our pharmacy program: You may submit a coverage review request online through one of these ePA portals: Surescripts, CoverMyMeds, or ExpressPAth.
3. If you do not have access to an ePA system, you can contact 877-417-1839 to submit your request or complete the Standard Medication Prior Authorization form.
4. Remember: Always view our Pharmacy Policies prior to submitting your coverage review request.
   
   

Once you submit your request:

• If the request meets criteria, Well Sense Health Plan will cover the drug
• If the request is denied, the member and the authorized appeal representative have the right to appeal the decision

Questions?

Call our Provider Service Center at 877-957-1300 or email us with questions about guidelines, submitting forms, or to request a printed version of any guideline or form.