Here is our current prior authorization (coverage review) process:

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 877-417-1822 for MassHealth members or 877-417-0528 for Qualified Health Plan members. Or, you can submit the appropriate Standard Medication Prior Authorization Form:
   
   MassHealth 
   Qualified Health Plan
4. As always, please view our Pharmacy Policies before submitting your coverage review requests.

Medical Benefit Drug Review for select drugs

Here is our current prior authorization (coverage review) process for six select Medical Drug policies:

5. Check the Massachusetts Medicaid and Qualified Health Plan Policy Topics and Covered HCPCS Drug Code List to see if a prior authorization is required for the medication, and associated J-code, you are requesting.

6. If you believe it is medically necessary for a member to take a medication that is not covered by our medical benefit program, you may submit a coverage review request via

• Fax by submitting the appropriate form below to (866) 539-7185
• Phone by contacting 877-417-1822 for MassHealth members or 877-417-0528 for Qualified Health Plan members.

7. As always, please view our Medical Drug Policies before submitting your coverage review requests