Prior Authorization for Medications
Request a PA for a Pharmacy Drug
- Check the formulary and our pharmacy policies to see if a prior authorization is required for a pharmacy drug.
- If prior authorization is required, select the member’s plan below for more information on how to submit a prior authorization.
- Online through an ePA portal
- 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
- Online through an ePA portal
- Fax a prior authorization form to 833-951-1680
- Call 877-417-0528 to initiate a prior authorization by phone
- Online through an ePA portal
- Fax a prior authorization form to 877-251-5896
- Call 877-417-1828 to initiate a prior authorization by phone
- Online through an ePA portal
- 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 877-417-1839 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:
- Online through an ePA portal
- Fax a prior authorization form to 877-251-5896
- Call 877-417-1828 to initiate a prior authorization by phone
Request a PA for a Medical Drug
Select drugs are available under the Medical Benefit.
- Check the HCPCS tool to see if prior authorization is required for a medical drug.
- Review the WellSense Preferred HCPCS Drug List for Massachusetts or the WellSense Preferred Drug List for New Hampshire to find a preferred drug for select classes of medications that require prior authorization.
- For MassHealth only, check to see if the requested medication is restricted to Medical Benefit Only
- Review our pharmacy policies for coverage requirements.
- If prior authorization is required, fax the appropriate form to 866-539-7185.
- Fax a prior authorization form to 866-539-7185
- Forms for drugs on the WellSense Preferred HCPCS Drug List for Massachusetts
- Forms for all other drugs are available on the MassHealth Drug List
- Forms for drugs on the WellSense Preferred HCPCS Drug List for Massachusetts
- Call 877-417-1822 to initiate a prior authorization by phone
- Fax a prior authorization form to 866-539-7185
- Forms for drugs on the WellSense Preferred HCPCS Drug List for Massachusetts
- Fax a prior authorization form to 866-539-7185
- Forms for drugs on the WellSense Preferred Drug List for New Hampshire
- Bevacizumab Products Medical PA Form
- Compliment Inhibitors Medical PA Form
- Erythrooiesis Stimulating Agents Medical PA Form
- Filgrastim Products Medical PA Form
- GnRH Agents Medical PA Forms
- Inflammatory Conditions Medical PA Forms
- Infliximab Products Medical PA Form
- Pegfilgrastim Products Medical PA Form
- Rituximab Products Medical PA Form
- Trastuzumab Products Medical PA Form
- Form for all other drugs: Standard Medication Prior Authorization Form
- Call 877-417-1839 to initiate a prior authorization by phone
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