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This document outlines the prior authorization process for certain medications managed under the IBM Managed Pharmacy Program by CVS Caremark, detailing the medications that require authorization,

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How to fill out IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists

1. Obtain the IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists form.
2. Review the specific medication or treatment requiring prior authorization.
3. Gather all necessary patient information, including demographics and insurance details.
4. Provide clinical information that supports the need for the requested medication or treatment, including diagnosis and previous therapies.
5. Complete all required sections of the form accurately, ensuring all information is clear and concise.
6. Attach any relevant medical records or supporting documents that might strengthen the prior authorization request.
7. Submit the form according to the guidelines provided, whether by fax, email, or through an online portal, if available.
8. Follow up to confirm receipt of the request and check on the status of the prior authorization.

Who needs IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

1. Individuals who require medications or treatments that are subject to prior authorization under the IBM Managed Pharmacy Program.
2. Healthcare providers prescribing medications that fall under the specialty guidelines.
3. Patients needing specific treatments that must be verified for medical necessity before insurance coverage applies.

People Also Ask about

What kind of drugs need prior authorization?

What types of prescriptions require prior authorizations? Brand-name drugs that have a generic available. Drugs that are only intended for certain age groups or health conditions. Drugs used only for cosmetic reasons. Drugs that are neither preventative nor used to treat non-life-threatening conditions.

What is specialty guideline management SGM?

SGM is a comprehensive utilization management program that helps promote patient safety and ensure appropriate utilization of specialty medications.

What is the phone number for CVS Caremark prior authorization?

For prior authorization review, your doctor should call CVS Caremark at 1-800-294-5979 before you go to the pharmacy.

What is a prior authorization for specialty drugs?

Prior authorization (PA) is an essential tool that is used to ensure that drug benefits are administered as designed and that plan members receive the medication therapy that is safe, effective for their condition, and provides the greatest value.

Are CVS Caremark and CVS Specialty the same thing?

CVS Health includes the company's retail business, which continues to be called CVS/pharmacy; its pharmacy benefit management business, which is known as CVS/Caremark; its walk-in medical clinics, CVS/MinuteClinic; and its growing specialty pharmacy services, CVS/specialty.

What is specialty guideline management?

SGM is a comprehensive utilization management program that helps promote patient safety and ensure appropriate utilization of specialty medications. With robust criteria and a higher touch clinical review, SGM helps payors control specialty utilization spend and keep patients on their path to better health.

For pdfFiller’s FAQs

What is IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

The IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists are tools used to determine the medical necessity and appropriateness of prescribed medications based on specific criteria set by the program.

Who is required to file IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

Healthcare providers, including physicians and other authorized prescribers who prescribe medications subject to prior authorization, are required to file the IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists.

How to fill out IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

To fill out the IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists, providers should gather necessary patient information, specify the requested medication, provide clinical rationale, and complete any forms that detail the patient's medical history and treatment plan.

What is the purpose of IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

The purpose of the IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists is to ensure that the medications prescribed are warranted based on clinical guidelines, enhance patient safety, and manage healthcare costs effectively.

What information must be reported on IBM Managed Pharmacy Program Prior Authorization and Specialty Guideline Management Lists?

The information that must be reported includes the patient's demographic details, the requested medication, current medical conditions, previous treatments, any relevant medical history, and supporting documentation that substantiates the request for prior authorization.