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Prior Authorization/Coverage Determination Procedure

If a member is requesting a coverage determination or an exception, please fill out the appropriate form below and fax your request to either Express Scripts at 877-837-5922 or Curascript at 888-773-7386.

A decision about whether SCAN will cover a Part D prescription drug can be a “standard” coverage determination (prior authorization) that is made within the standard timeframe typically within 72 hours. Turn around times for non-formulary exceptions and tier exceptions are typically within 72 hours upon receipt of completed information. If incomplete information is given, then the turnaround time will be delayed up to 14 days. Once a decision has been made, Express Scripts will send a letter to the physician’s office and the member regarding the decision of the coverage determination.

To check the status of a coverage determination and exception request, please call Express Scripts at 800-417-8164 or Curascript at 888-773-7376.

2008 Specialty General Request
2008 Non-Formulary Drug Request
2008 Tier Exception
Actimmune-interferon gamma 1b
Adagen
Aldurazyme
Anadrol-50
anagrelide-Agrylin
Ancobon-flucytosine
Aranesp-darbepoetin alfa
B vs. D- Immunosuppressants
B vs. D- Oral Anti-Emetics
Betaseron-interferon beta 1b
Byetta
Cancidas
Carimune
Celebrex-celecoxib
Copaxone-glatiramer
demeclocycline-Declomycin
desmopressin-DDAVP
Elmiron-pentosan polysulfate sodium
Emend-aprepitant
Enbrel-etanercept
Entocort EC-budesonide
Felbatol-felbamate
Forteo-teriparatide
Gammagard-immune globulin
Gleevec-imatinib
Humira-adalimumab
Intron A-interferon alfa-2b
Iplex
Liptior 80mg-atovastatin
Lyrica-pregabalin
Marinol-dronabinol
Miacalcin Inject-calcitonin salmon
midodrine-ProAmatine
Myfortic
Naglazyme
nefazodone-Serzone
Neupogen-filgrastim
Neutrexin
Nexavar-sorafenib
Nimotop-nimodipine
Noxafil
Omacor-omega 3 acid ethyl esters
Orfadin-Nitisinone
Peg Intron-peginterferon alfa
Procrit-epoetin alfa
Prograf-tacrolimus
Proleukin
Provigil-modafinil
Ranexa-ranolazine
Raptiva-efalizumab
Relistor-Methylnaltrexone
Revatio-sildenafil citrate
Revlimid-lenalidomide
Rilutek-riluzole
Roferon A-interferon alfa 2a
Sensipar-cinacalcet
Serostim-somatropin
Somavert-Pegvisomant
Soriatane-acitretin
Sprycel-Dasatinib
Strattera-Atomoxetine
Sutent-sunitinib
Symlin-pramlintide acetate
Tarceva-erlotinib
Targretin-bexarotene
Thalomid-thalidomide
Thioguanine
thioridazine-Mellaril
ticlopidine-Ticlid
Topamax-topiramate
Trisenox-Arsenic Trioxide
Tykerb
Velcade-Bortezomib
Vidaza-Azacitidine
Zavesca-Miglustat
Zolinza


Physician Coverage Determination Link



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