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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Confirmación de requisitos de autorización previa

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. Para conocer el estatus de una solicitud o si desea obtener información general, puede contactar al MIT llamando al 1-866-315-7587 de lunes a viernes de 8 a.m. a 8 p.m., hora del Este.

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.

Visite CoverMyMeds

Folleto de CoverMyMeds

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

Solicitud de determinación de cobertura

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.

  • Teléfono

    CarePlus Clinical Pharmacy Review
    866-315-7587

    Estamos disponibles de lunes a viernes de 8 a.m. a 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 se asocia con CoverMyMeds para ofrecer determinaciones en tiempo real para solicitudes en línea. Your registration is required, please use the Folleto de CoverMyMeds para inscribirse manera rápida y fácil..

  • En línea

    Complete the Coverage Determination Request Form (in Inglés o español)

    Es un formulario general que no es específico para su medicamento. Es posible que la Unidad de Coordinación de Farmacia de CarePlus necesite contactarse con usted para obtener más información antes de que podamos tomar una determinación sobre el medicamento.

    También puede usar el formulario de solicitud de determinación de cobertura de los Centros de Servicios de Medicare y Medicaid (CMS)

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Última actualización:

01/01/2026