To be sure that certain medications are used appropriately, prior authorization (plan approval) may be required before prescriptions for these drugs can be filled. Prior authorization may be required for the following drugs and reasons:
- Non-formulary medications or benefit exceptions required by medical necessity
- All brand name medications when there is an A-rated generic version available
- Medications and/or treatments if they are under clinical investigation
- Medications prescribed for non-FDA approved uses
- Prescriptions that exceed set plan limits (days' supply, quantity, cost)
- New-to-market products
- Medications that have treatment guidelines developed by the Health Partners Plans’ Pharmacy & Therapeutics Committee
Prior Authorization requests may be submitted by the member or the provider; however, supporting clinical information is usually needed from the provider. They can be faxed to 1-866-371-3239.
You can also call us to make a request at 1-866-901-8000 (TTY 1-877-454-8477), or mail it to:
Attention: Pharmacy Dept.
Health Partners Medicare
901 Market Street, Suite 500
Philadelphia, PA 19107