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.

2009 Non-Formulary Drug Request Form 2009 SCAN tier exception form 2009 Specialty Prior Authorization Request.pdf Adagen-pegademase bovine Adcirca-Tadalafil Afinitor-everolimus Aldurazyme-laronidase Anadrol-50-oxymetholone Anagrelide-anagrelide Ancobon-flucytosine Aranesp-darbepoetin alfa B vs. D Anti-Emetics inj B vs. D Carimune-immune globulin B vs. D Engreix-B -hepatitis B B vs. D Recombivax-hepatitis B B vs. D Vidaza-azacitidine B vs. D- Anti-Cancer B vs. D- Immunosuppressants B vs. D- Oral Anti-Emetics Betaseron-interferon beta 1b Byetta-exenatide Campath-alemtuzumab Cancidas-caspofungin Celebrex-celecoxib Copaxone-glatiramer Elitek-rasburicase Elmiron-pentosan polysulfate sodium Emend-aprepitant Enbrel-etanercept Entocort EC-budesonide Fentanyl citrate lozenges -fentanyl citrate Forteo-teriparatide Gammagard-immune globulin Gleevec-imatinib Humira Crohns-adalimumab Humira-adalimumab Iplex-mecasermine rinfabate Liptior 80mg-atovastatin Lovaza-omega-3-acid-ethyl esters

Lyrica-pregabalin Miacalcin Inject-calcitonin salmon Naglazyme-galsulfase Neupogen-filgrastim Neutrexin-trimetrexate glucronate Nexavar-sorafenib Noxafil-posaconazole Ontak-denileukin diftitox Orfadin-Nitisinone Peg Intron-peginterferon alfa Pegasys-interferon alfa-2a Procrit-epoetin alfa Proleukin- aldesleukin Provigil-modafinil Ranexa-ranolazine Relistor-methylnaltrexone Revatio-sildenafil citrate Rilutek-riluzole Rituxan-rituximab Sensipar-cinacalcet hcl Serostim-somatropin Simponi-golimumab Somavert-pegvisomant Soriatane-acitretin Sprycel-dasatinib Strattera-atomoxetine Sutent-sunitinib Symlin and Symlinpen-pramlintide acetate Targretin-bexarotene Tasigna- nilotinib Thalomid-thalidomide Thioguanine-thioguanine Topamax-topiramate Trisenox-arsenic trioxide Tykerb-lapatinib Velcade-bortezomib Zavesca-miglustat Zolinza- vorinostat

To view all of the Prior Authorization Criteria please click here



Physician Coverage Determination Link