CVS Caremark Prior Authorization Fax Number

Which line takes which request

Caremark’s Prior Authorization page splits requests by the member’s coverage:

• Medicare Part D. Fax (855) 633-7673, phone (855) 344-0930, or ePA. For a Part D determination, Caremark tells you to see the member’s plan website for the form and instructions.
• Medicaid. Fax (866) 255-7569, phone (877) 433-7643, or ePA.
• Non-Medicare. ePA at caremark.com/ePA or phone (800) 294-5979. The page lists no fax here.

The Texas and New Hampshire forms print fax lines of their own: (888) 836-0730 for non-specialty drugs and (866) 249-6155 for specialty drugs. New Hampshire’s form labels the non-specialty line Commercial. Caremark’s Colorado form asks for ePA, or fax (855) 245-2134 for Exchange business.

The Global form now asks for ePA

Caremark’s Global Prior Authorization Form, revision 081826, carries one routing instruction: “Please submit prior authorization (PA) requests electronically via ePA.” It prints no fax line to send the form to. The earlier revision 031824, still served at the form’s old address, says to fax it to 1-888-836-0730, so that number still turns up when you search for a Caremark fax.

Use the line printed on the form you are filing. If your form prints none, use ePA or call (800) 294-5979.

What to send

The Global form asks for the following, and state forms ask for much the same:

• Patient name, date of birth and patient ID
• Prescriber name, NPI, office phone and secure office fax
• Medication and strength, directions, quantity, day supply and ICD-10 code
• The medications already tried, with the reason each failed or was contraindicated
• The prescriber’s signature

The form warns that “solely providing demographic and drug information may not constitute a sufficient request for coverage”, so attach the relevant clinical documentation. An expedited review is a box on the form, and checking it certifies that the standard time frame may seriously jeopardize the patient.

Who sends the request

Caremark says the member will be asked to have their health care provider, or the provider’s authorized agent, contact its Prior Authorization Department. That makes this a task for the prescriber’s office. A member with a question about their own prescription should start with the CVS Caremark member guide.

Before you send

Caremark has retired one fax line from its Global form while older copies still circulate.

• Download the form from Caremark’s Prior Authorization page today rather than reusing a saved copy, and read the number on it.
• For Medicare Part D, follow the member’s plan website if it gives a different destination.
• File the delivery confirmation with the request. It shows the fax reached the number, not that Caremark has decided anything.

A secure office fax for the practice

Caremark’s form asks for the prescriber’s secure office fax, and its New Hampshire form describes that field as the number for “sending prior authorization determinations to the prescribing provider”. Every paid FaxTerra plan includes a fax number with an inbox on the web and in the mobile app, so the practice receives on the same account it sends from.

The Business Associate Agreement comes with the HIPAA compliance add-on at $4.99 a month on any paid plan, signed before the first PHI is sent. The free plan carries no BAA.