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.

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Community Mental Health Center Providers Only

Prior Authorization requirements for Behavioral Health Medications for CMHC providers in NH:

Other Drug Exceptions

Use the forms below to request a prior authorization for drugs not found in our formulary, newly marketed drugs, brand-name drugs or for quantity limit exceptions.