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Contracting and Practice Changes

Member-Related Forms

Pharmacy Prior Authorization

REMINDER – Effective October 2022, pharmacy claims and prior authorizations for drugs dispensed and billed by a pharmacy should be directed to the single pharmacy benefit manager (SPBM), Gainwell Technologies. Information for providers on pharmacy pages has been reflected as notification ahead of October for the go-live of SPBM.

For prior authorizations through 9/30/2022, please continue to submit to CareSource via portal or fax at 866-930-0019 for drugs processed through the pharmacy benefit. Prior authorization forms are available in the Provider Portal. Pharmacy claims will continue to be processed by Express Scripts through 9/30/2022.

View the Unified Preferred Drug List (UPDL) here

Medical Prior Authorization



Fraud, Waste and Abuse