A prescription drug coverage determination is used to request a drug formulary exception for medications that are not on CommunityCare's formulary list or drugs that are on CommunityCare's formulary list but require a utilization management decision (prior authorization, quantity limit or step therapy).

• Commercial Prescription Coverage Determination Form (Large Group, Grandfathered and Traditional Plans)
• QHP Coverage Determination Form (Small Group and Individual ACA Plans)

Electronic Prescription Drug Prior Authorization

Effective July 10th 2023, CommunityCare has partnered with CVS to offer free electronic prescription drug prior authorization (ePA) services to all providers and their staff for ALL CommunityCare prescription drug benefits. ePA helps prescribers and pharmacies quickly find, complete and submit Prior Authorization (PA) requests for all plans and medications. Providers can use the CVS web-based portals through SureScripts or CoverMyMeds to send prescription drug PA requests to CommunityCare.

It’s easy to start an ePA! Start taking advantage of fast, reliable electronic prior authorizations today! If you are not already using SureScripts or CoverMyMeds, all you need to do is register for a free account at one of the following web links below. Existing SureScripts or CoverMyMeds users need to use the links below to access CommunityCare members.

• SureScripts
• CoverMyMeds

What is ePA? You can find more information with Caremark's ePA FAQs.

Have more questions about ePA? Please contact our Pharmacy Help Desk at (918) 594-5211 or 1-877-293-8628, or you can visit the Caremark website for more information.

If you have additional questions, please contact your provider relations representative or the Pharmacy Help Desk at (918) 594-5211 or 1-877-293-8628.