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Prior Authorization Information. CVS Caremark Prior Authorization (PA) tools are developed to ensure safe, effective and appropriate use of selected drugs. Prior Authorization can ensure proper patient selection, dosage, drug administration and duration of selected drugs.
Please contact CVS/Caremark at 1-888-413-2723 with questions regarding the prior authorization process. When conditions are met, we will authorize the coverage of the medication.
COVERAGE CRITERIA. The requested drug will be covered with prior authorization when the following criteria are met: • The requested drug will be used with a reduced calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term.
Prior Authorization Forms. PA Forms for Physicians. When a PA is needed for a prescription, the member will be asked to have the physician or authorized agent of the physician contact our Prior Authorization Department to answer criteria questions to determine coverage.
The requested drug will be covered with prior authorization when the following criteria are met: • The requested drug will be used with a reduced calorie diet and increased physical activity to reduce excess body
COVERAGE CRITERIA The requested drug will be covered with prior authorization when the following criteria are met: • The patient has a diagnosis of type 2 diabetes mellitus AND • The patient has NOT been receiving a stable maintenance dose of a GLP-1 (glucagon-like peptide 1) Agonist for
Authorization may be granted when the requested drug will be used with a reduced calorie diet and increased physical activity for chronic weight management in an adult when ALL of the following criteria are met:
Authorization may be granted for a diagnosis of type 2 diabetes mellitus when the following criteria is met: The patient has been receiving a stable maintenance dose of the requested drug for at least 3 months. The patient has demonstrated a reduction in A1C since starting this therapy.
Authorization may be granted when the requested drug will be used with a reduced calorie diet and increased physical activity for chronic weight management in an adult when ALL of the following criteria are met:
Our employees are trained regarding the appropriate way to handle members’ private health information. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. 1.