Pharmacy

Electronic Prior Authorization (ePA):

ePA is the preferred method to submit Prior Authorization requests to Express Scripts for pharmacy benefit drugs. Providers may use ePA through ExpressPAth, Surescripts, CoverMyMeds or through the Electronic Health Record.

Prior authorization requests for medical drugs administered in a doctor's office will be reviewed by Care Continuum, a subsidiary of Express Scripts. See information in Medical Injectable Drug Prior Authorization Resources.

Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions

Prior Authorization Criteria Updates

Effective July 1, 2022
Effective August 1, 2022
Effective September 1, 2022
Effective October 1, 2022
Effective November 1, 2022
Effective December 1, 2022
Effective January 1, 2023
Effective February 1, 2023
Effective March 1, 2023
Effective April 1, 2023
Effective June 1, 2023
Effective September 1, 2023

Care Continuum reviews Medical Drug Prior Authorization requests for all UCare plans.

• See the Medical Injectable Drugs requiring prior authorization.
• Review Medical Drug Policies.

To submit an authorization request, use one of the following ways:

• Online (ePA) via the ExpressPAth Portal at www.express-path.com/. Providers can submit requests, check on the status of submitted requests, and submit an authorization renewal on the ExpressPAth Portal. The site also provides 24/7 access, potential for real-time approvals, and email notifications once a decision is reached.
• Fax an authorization form to Care Continuum at 1-877-266-1871.
• Call Care Continuum at 1-800-818-6747.
  

To request an adjustment to an existing prior authorization:

• Providers should contact Care Continuum for prior authorization changes.
• The authorization must be active.
• End date extensions can be completed due to scheduling issues or health reasons (ex: chemo delayed due to blood count) that may prevent the administration of the previously approved drug.
• Required information for these requests:
  • Reason for extension.
  • Revised end date.
• Adjustments are not approved for the reasons listed below. A new review/renewal is required.
  • Additional drug is requested.
  • The patient is due for a renewal.

Non-participating providers should send requests using this form:

• by fax to UCare Clinical Pharmacy Intake at 612-617-3948.
• or by mail to UCare, Attn: Pharmacy at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that received a claim denial due to no authorization in place will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form. 

Pharmacy Benefit Prior Authorization
Express Scripts – UCare Individual & Family Plans and State Medical Assistance Programs
Phone: 1-877-558-7523
Fax: 1-877-251-5896

Medical Injectable Drug Prior Authorization
Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at www.express-path.com/.
Phone: 1-800-818-6747
Fax: 1-877-266-1871

UCare Clinical Services Intake
Fax: 612-884-2300

Specialty Pharmacy Contact Information
Fairview Specialty Pharmacy
Phone: 612-672-5260 or 1-800-595-7140 toll free
Fax: 1-866-347-4939
https://www.fairview.org/services/specialty-pharmacy
*exclusive network provider of specialty drugs for UCare Individual & Family Plans and State Medical Assistance Programs

Mail Order Contact Information
Express Scripts Mail Order Pharmacy
Phone: 1-866-544-7950
Fax: 1-800-837-0959
ePrescribing: Express Scripts Home Delivery Pharmacy