Minnesota Health Care Programs (State Medical Assistance Programs)
The Pharmacy Benefit Manager (PBM) for all UCare members is Express Scripts, Inc. (ESI).
UCare Connect (SNBC) | MinnesotaCare (MnCare) | Prepaid Medical Assistance Program (PMAP)
Minnesota Senior Care Plus (MSC Plus)
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.
Care Continuum reviews Medical Drug Prior Authorization requests for all UCare plans.
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 – State Medical Assistance Programs and Individual & Family Plans
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
*mail order services are not available for State Medical Assistance Program members