Pharmacy

2024

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

For info on Medical Injectable Drug Prior Authorization requests, see "Medical Injectable Drug Prior Authorization Resources" on the Pharmacy page.

2023

Authorization requests for pharmacy benefit drugs will not be accepted by ExpressScripts after Dec. 31, 2023.

Request for Medicare Prescription Drug Coverage Determination Form

See the Medical Injectable Drugs requiring prior authorization.

Review Medical Drug Policies.

Participating providers can submit prior authorization, authorization adjustment and pre-determination requests to Care Continuum 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 request form to Care Continuum at 1-877-266-1871.
• Call Care Continuum at 1-800-818-6747.

Non-participating and MultiPlan providers can submit prior authorization, authorization adjustment and pre-determination requests to UCare one of the following ways:

• Fax an authorization request form to UCare Clinical Pharmacy Intake at 612-617-3948.
• By mail to UCare, Attn: Pharmacy at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that receive a claim denial will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

Transition Policy (updated 12/2021)

Pharmacy Benefit Prior Authorization - Navitus Health Solutions *New PBM for 2024*

Medicare and Medicare + Medical Assistance (dual eligibles)

• Phone: 1-833-837-4300
• Fax: 1-855-668-8552

Medical Injectable Drug Prior Authorization
Participating Providers Contact
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

Non-Participating Providers Contact
UCare Clinical Pharmacy Intake:

• Phone: 612-676-6504
• Fax: 612-617-3948

Fairview Specialty Pharmacy

• Phone: 612-672-5260 or 1-800-595-7140 toll free
• Fax: 1-866-347-4939
• Website: https://specialtypharmacy.fairview.org

Lumicera Specialty Pharmacy *New for 2024*

• Phone: 1-855-847-3554
• Fax: 1-855-847-3558
• Website: www.lumicera.com

Costco Mail Order Pharmacy *New for 2024*

• Phone: 1-800-607-6861
• Fax: 1-877-258-9584
• ePrescribing: Costco Mail Order Pharmacy #1348