ConnectorCare / Qualified Health Plans

Review clinical criteria and submit a prior authorization if necessary.

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:
  4. As always, please view our Pharmacy Policies before submitting your coverage review requests.

Other Drug Exceptions

Use the forms below to request a prior authorization for a newly marketed drug, a brand-name drug, or for quantity limit exceptions.

Contact us with questions about guidelines, submitting forms, or to request a printed version of any guideline or form.

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