Microsoft word - priorauthorizationguide

Colorado Choice/SLVHMO
Pharmacy Guide
700 Main Street, Suite 100
Alamosa, CO 81101
Phone: (719) 589-3696
Fax: (719) 589-4995

Communication of Information
To ensure rapid patient care, effective communica- Telephone
tion of information between prescribing physicians and Prescription Solutions Prior Authorization Team members is required. You need to provide complete clinical information when requesting prior authorizations. Information required for prior autho- option “2” anytime after the first 20 Patient’s pertinent medical test results- Requests for prior authorization with incomplete or missing information will not be considered com- plete until all information is provided. Faxed re- quests with incomplete or missing information will ing/Additional Information Fax form and, if applica- ble, the Drug Specific Form. Phone requests that cannot be completed during the initial call because of incomplete or missing information will be given a telephone number to call when the information is available, or, if applicable, a fax number to fax re- able, you will be asked to phone and/or fax back the in-
Prior Auth Fax Process
4. Locate and record the missing and/or additional information on fax form(s) received from Prescription Solutions Prior Authoriza- 1. Ensure all relevant member and clinical information is 5. Call or fax additional information to RxSolutions Prior Authoriza- 2. Fax the request form to Prescription Solutions Prior Au- tion Department using the numbers indicated on the Request for Missing/Additional Information form within 48 hours. 3. If fax is incomplete or additional information is required, 6. Decisions are rendered upon receipt of all information and writ- ten communication of the decision will be faxed w/in 48 hours. Decision on requests pending information will be rendered not If additional information is needed, follow next steps:
exceeding 48 hours from receipt of all information. DRUGS NEE DI NG A P R I O R AUT HO RIZ AT I O N
Excluded Drugs
INJECTABLE AFTER HOURS POLICY
Prescription Solutions
4. If the requested injectable is not listen on Colorado Choice/SLVHMO will cover certain the after hours injectable drug list, have injectable medications at a contracted retail the member call the prescribing physician pharmacy if a Prior Authorization has been receives a prescription for an injectable me- Name of Injectable
Maximum supply
dication after hours and a prior authorization Anti-inhibitor complexes (Autoplex T, NovoSe- has not been obtained, the following proce- dure would apply to ensure prompt appropri- DDAVP -5 days
Local Pharmacies may
Factor VIII Products (Alphanate, Koate-DVI, member presents a prescription for an inject- supply injectables in an
able medication from the list below and Pre- urgent situation if they
scription Solutions Clinical Pharmacy De- have them available.
partment is not available the pharmacist 1. Fill the prescription for no more than the Interferon-Alpha Products (Alferon-N, Intron-N, quantity specified in the following chart. 2. Call Prescription Solutions Help Desk at (800) 788-7871 during the next working
Gentiva Health Services
day for a one-time override and to
3. Notify the physician’s office of the need for Prior Authorization if the prescription calls for duration of therapy greater than 5 days. Please have physician call Prior Authorization at (800) 711-4555.

Source: http://cochoice.com/wp-content/uploads/2013/10/PharmacyPriorAuthorizationGuide.pdf