WebCVS Caremark Prior Authorization 1300 E. Campbell Road Richardson, TX 75081 Phone: 1-866-814-5506 Fax: 1-866-249-6155 www.caremark.com Page 1 of 3 Taltz Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified. WebCVS Caremark Specialty Programs 2969 Mapunapuna Place Honolulu, HI 96819 Phone: 1-808-254-4414 Fax: 1-866-237-5512 www.caremark.com Page 1 of 5 Simponi HMSA - Prior Authorization Request CVS Caremark administers the prescription benefit plan for the patient identified.

Caremark - Prior Authorization Forms

WebCVS/caremark. Formulary Exception/Prior Authorization Request Form Patient Information Prescriber Information Patient Name: Prescriber Name: Patient ID#: Address: Address: … elasticsearch join type

Prior Authorization Criteria Form - Caremark

WebMemberName:{{MEMFIRST}}{{MEMLAST}}DOB:{{MEMBERDOB}}PANumber:{{PANUMBER}} Sendcompletedformto:CaseReviewUnit,CVSCaremarkPriorAuthorizationFax:1-866-249-6155 WebAutoimmune Conditions (FA-PA) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to CVS/Caremark at 1-888-836-0730. Please contact CVS/Caremark at 1-855-240-0536 with questions regarding the prior authorization process. WebCONTINUATION OF THERAPY (PA RENEWAL) Cosentyx (secukinumab) **Check www.fepblue.org/formulary to confirm which medication is part of the patient’s benefit NOTE: Form must be completed in its entirety for processing 1. Has the patient been on Cosentyx continuously for the last 6 months, excluding samples? Please select answer below: elasticsearch job description