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 QHP members. Or, you can submit the General Medication Request 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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