Pharmacy

Electronic Prior Authorization (ePA): 

ePA is the preferred method to submit Prior Authorization requests to Express Scripts for pharmacy benefit drugs. Providers may use ePA through ExpressPAth, Surescripts, CoverMyMeds or through the Electronic Health Record.

Starting Jan 1, 2020, prior authorization requests for medical drugs administered in a doctor's office will be reviewed by Care Continuum, a subsidiary of Express Scripts. See information in Medical Injectable Drug Prior Authorization Resources. 

2020

Beginning Jan.1, 2020, Care Continuum, a subsidiary of Express Scripts, will review Medical Drug Prior Authorization requests for all UCare plans. See the 2020 Medical Drug PA bulletin.

See more information by selecting a UCare Plan at the top of this page and reviewing Medical Injectable Drug Prior Authorization Resources.  

The Pharmacy and Therapeutics Committee, a group of practicing physicians and pharmacists, meets up to six times per year to recommend medication inclusion or exclusion to our formularies. The Pharmacy and Therapeutics Committee evaluates drugs based on clinical evidence and efficacy (drug monographs, peer reviewed literature, compendia resources), therapeutic guidelines, medication safety and comparable data to other therapeutic alternatives. This committee reviews all new drugs approved by the FDA, new generics, new dosage forms, new indications as well as regular therapeutic class reviews and annual review of all utilization management criteria.

January 2019 Decisions
November 2018 Decisions
September 2018 Decisions
June 2018 Decisions
March 2018 Decisions
January 2018 Decisions


 

Pharmacy Benefit Prior Authorization

Medical Injectable Drug Prior Authorization

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