Medicare Part D transition plans are time-limited and often cumbersome. When medications members and their physicians feel are essential are restricted or limited, a prior authorization request is needed. When the drug is not on the plan at all, an exception must be filed. Each plan has a different process and form.
An accessible central location for Part D prior authorization & exception information has been identified as a need by frontline workers. Community Partners is looking to members of the statewide Health Access Network to share forms and updated information to make this resource as useful as possible. Please email Community Partners with any additions and corrections.
Several of these forms, links to plan websites and specific processes are are listed here.
AdvantraRx Prior Authorization form
Bluecross Blue Shield Prior Authorization form (This form is not for Blue Medicare Rx)
HealthNet Prior Authorization form
Humana Prior Authorization form
Rx America/Advantage Star & Advantage Freedom Prior Authorization form
WellCare form for Prior Authorizations and Exceptions
Unicare/Medicare Rx Rewards webpage of Prior Authorization forms
AARP MedicareRx/United Healthcare plan requires physicians to fax a letter requesting an exception, including the requested medication and reasons for the exception.
Prior authorizations generally apply to medications that are included in a plan's formulary. To obtain approval for a drug not on the formulary (or to seek a lower cost sharing for a drug that is on the formulary) you must seek an exception. For a list of Plan Exception contacts and instructions, click here.
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