UCare Individual & Family Plans, UCare Individual & Family Plans with M Health Fairview
The Pharmacy Benefit Manager (PBM) for all UCare members is Express Scripts, Inc. (ESI).
2023 UCare Individual & Family Plans / UCare Individual & Family Plans with M Health Fairview web page
2022 UCare Individual & Family Plans / UCare Individual & Family Plans with M Health Fairview web page
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 March 1, 2022
Effective April 1, 2022
Effective May 1, 2022
Effective June 1, 2022
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
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 Services at 612-884-2300.
- or by mail to UCare, Attn: Clinical Services 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
Medical Injectable Drug Prior Authorization
Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at www.express-path.com/.
UCare Clinical Services Intake
Specialty Pharmacy Contact Information
Fairview Specialty Pharmacy
Phone: 612-672-5260 or 1-800-595-7140 toll free
*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
ePrescribing: Express Scripts Home Delivery Pharmacy