What are the Benefits of using Cover My Meds?
Cover My Meds (ePA) allows a provider to:
- Electronically request prior authorization criteria for a member and a medication
- Receive the member-specific criteria
- Submit answers to the criteria
- Receive a determination often times in less than an hour
ePA is intended to extend prior authorization process access to a provider’s electronic health record through a real-time request for criteria and delivery of that criteria to your Electronic Health Records system( such as Allscripts, NextGen, etc) for completion. For Medications not found on some of our Formularies, often times an alternative drug will be suggested.
Cover My Meds Portal
Available to use for all Affinity Plans. To register for a free CoverMyMeds account, create an account. Setting up an account only takes a few minutes. Furthur step-by-step instructions can be found in the Reference Guide. Instructions also include adding a group, for offices with multiple providers for greater ease.
For Medications not listed on the Formulary
Providers may follow the same course of action as with a Coverage Determination, also called a Prior Authorization. This can be initiated by having your Provider call 855.582.2022 and request a Coverage Determination for the Medication(s) whether or not it is listed on the Formulary. Should this coverage be denied, an appeal can be made within 60 days of the initial denial by calling 888.543.9069 (choose option 1 for pharmacy appeals) or by having the Provider fax clinical chart notes or a letter of medical necessity to 718.536.3383.
Medicaid and Child Health Plus
(For prompter service please contact CVS/ Caremark For Prior Authorizations)
Monday - Friday, 9:00 am - 7:00 pm
877.432.6793
Fax: 866.255.7569
Medical and Pharmacy Prior Authorization Criteria
Enriched Health Plan (HARP)
(For prompter service please contact CVS/ Caremark For Prior Authorizations)
Monday - Friday, 9:00 am - 7:00 pm
877.432.6793
Fax: 866.255.7569
Essential Plan
(For prompter service please use the Cover My Meds Portal or you can call CVS)
Monday - Friday, 9:00 am - 7:00 pm
855.294.5979
Fax: 855.245.2134