Helpful Hints When Submitting Pharmacy Authorization Requests
We appreciate your partnership in providing excellent care and service to our members. As your business partner, we are always looking for ways to enhance your experience with us. One improvement we’d like to make is to reduce invalid pharmacy authorization requests. They can cause you and your staff unnecessary re-work and result in delays for your patients. Here are some helpful hints to follow when submitting a pharmacy authorization request form:
Check the Formulary on HNE.com: Most requests that we receive are unnecessary. They may be for drugs that do not require prior authorization, or the member might already meet the benefit requirement (e.g., he or she already completed the Step Therapy requirement). The on-line Formulary provides coverage information about all the drugs we cover, including:
- Prior authorization requirements
- The generic equivalents for brand name drugs
- Quantity limitations
- Step therapy parameters, including a listing of first line drugs
Whether or not the authorization reviewer is HNE or our HNE Pharmacy Benefit Manager PBM make sure the member has their pharmacy benefit through HNE. Some of our employer groups do not have their pharmacy benefit through HNE. Their benefits are ‘carved out’. The employer groups below have a carve-out pharmacy benefit. For your convenience, we have provided contact information for the groups Pharmacy vendor.
|Group||Pharmacy Vendor||Contact Number|
|Sisters of Providence
|The Diocese of Springfield||CVS Caremark||800-565-7091|
|Baystate Health Systems||Med Metrics||866-865-0147|
Please remember that the turnaround time for prior authorizations is 24-48 hours. We do our best to turn these requests around as quickly as possible. If you are waiting for a response to a prior authorization request, please do not submit a duplicate request. This can cause rework and result in a delay in processing the request
We appreciate your patience!
[dbrown11]Are all these phone numbers correct, verified?