Prior authorization for Parts B and D
Prior authorization may be required for certain professionally administered drugs (Part B) and pharmacy drugs (Part D) to ensure they are medically necessary.
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Confirming prior authorization requirements

Before submitting a prior authorization request, visit our Prior authorization and Prior authorization and Notification Lists (PAL) page to verify that the services or items require prior authorization. The list includes services and medications (e.g., medications delivered in the physician’s office or clinic or an outpatient or home setting) that require prior authorization before services are provided or administered.

Submit a prior authorization request

Use these steps to submit a request for administered drugs (Part B) or pharmacy drugs (Part D).

Administered drugs Pharmacy drugs

Fax: Complete the form below and fax it to CarePlus Clinical Pharmacy Review at 1-800-819-6204. To obtain the status of a request or for general information, you may contact the MIT by calling 1-866-315-7587, Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

Online: Availity Essentials™ is a trusted online portal that enables users to securely submit and check the status of prior authorization and referral requests. For information on how to register, log in, and access additional important resources, please visit our Availity page.

Online: CarePlus partners with CoverMyMeds® to allow prescribers to submit and check the status of prior authorization requests submitted online. Register or log in to access this service directly. For more information, review the flyer below.

Visit CoverMyMeds

CoverMyMeds flyer

Phone: Call 1-866-315-7587, Monday – Friday, 8 a.m. – 8 p.m., local time.

Fax: Complete the form below and fax it to 1-800-310-9071.

Medical Precertification Request Form

Request for coverage determination

Certain medications require a determination before they can be covered by CarePlus. If your patient's medication falls into this category, you will need to request and obtain approval for CarePlus to provide coverage. If a request is denied, a request for redetermination (appeal) may be submitted.

  • Phone

    CarePlus Clinical Pharmacy Review
    866-315-7587

    We are available Monday - Friday, 8 a.m. to 8 p.m.

    If you call this number, we can answer any questions and provide a coverage determination form specifically for the requested drug. Then you can submit the completed form by fax at: 800-310-9071

  • CoverMyMeds

    CarePlus partners with CoverMyMeds to provide real-time determinations for requests submitted online. Your registration is required, please use the CoverMyMeds flyer  for a quick and easy registration.

  • Online

    Complete the Coverage Determination Request Form (in English or Spanish)

    This is a general form that is not medication-specific. The CarePlus Pharmacy Utilization Management Unit may need to contact you for additional information before we can make a determination for the drug.

    Another option is to use the Centers for Medicare & Medicaid Services (CMS) Coverage Determination Request Form.

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Last Updated:

01/01/2026