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Pharmacy
Everything you need to know about our formularies, submitting authorizations, finding network pharmacies, and more.
Part D Drugs
Prior authorization criteria
How to submit a coverage determination request
Part D drugs requiring prior authorization are submitted directly to CVS/Caremark. To file a coverage determination request or tier exception request:
Call the CVS Caremark Coverage Determination line at 1-855-344-0930.
Submit online
Download for printing
- Printable coverage determination request form
- Printable redetermination request form
- Reconsideration forms
Submit directly
- CoverMyMeds
- ePA portal. ePA is easily accessible through a web-based portal or may be integrated into your Electronic Health Record (EHR) platform.
Part B Drugs
Prior authorization criteria
How to submit a prior authorization request
Prior authorization for Part B drugs should be submitted through Availity.
Oncology Prior Authorizations
Authorizations for oncology services are requested and processed through Oncohealth.
Prior authorizations should be submitted through the OncoHealth platform.
- In Availity, select “Oncology Authorization Request” under the Applications tab on the home screen, or
- Go to Devoted Health’s payer space in Availity, and select “Oncology Authorization Requests”
Questions?
Email: provider-relations@oncohealth.us or call 1-888-916-2616.
Additional resources
2024 OTC Catalog
Coverage Criteria
Internal coverage criteria for medical services
Clinical Guidelines
Drug Shortages
Stay informed about drug shortages & discontinuations
Inflation Reduction Act and Medicare
Medication Therapy Management
Prescription Supplies & Delivery
Learn about 100-day supplies & delivery