How to Initiate Prior Authorization with SilverScript or CVS Caremark (CVS)
Certain prescription medications need to be preapproved by SilverScript or CVS before they will be covered. This preapproval process is known as prior authorization. If you do not receive approval for drugs requiring prior authorization, you may pay the full cost of the medication.
In general, prior authorization may be required for medications that have serious side effects; are harmful when combined with other medications; should be used only for certain health conditions; are often misused or abused; or are prescribed when less expensive alternatives might work better.
Your doctor can initiate the prior authorization process by visiting the online portal or by calling the plan’s toll-free prior authorization line:
- SilverScript (Medicare)
- 855-344-0930
- CVS (Non-Medicare)
- 800-294-5979
If you intend to have your prescription for a prior authorization medication filled at a network retail pharmacy, you should strongly consider completing the prior authorization process before you go to the pharmacy. A registered pharmacist working at the network retail pharmacy may be able to assist in the process.
If approved, your prescription will be filled within any stated plan limits. If the medication is not approved for coverage, you will be responsible for paying the full cost of the medication. However, rejection of coverage may be appealed by following your plan’s appeal process. For more information, contact your plan directly.