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:
- Check the formulary to see if prior authorization is required for a medication.
- 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.
- 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.
- 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
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.