Skip to Main Content
Policies and Guidelines

Prior Authorization for Pharmacy Benefit Drugs

Applies for 2020 Prior Authorization Requests and Formulary Exceptions

Medica requires prior authorization for certain drugs administered under a Medica member's pharmacy benefit. Starting January 1, 2020, this program will be administered by Express Scripts®. When a prior authorization is needed for a prescription, the member will be asked to have the physician, or authorized agent of the physician, contact Express Scripts’ Prior Authorization Department to answer criteria questions to determine coverage.

Prior authorization and formulary exception requests may be submitted for review starting January 1, 2020. Included below is the information you need to submit a request on behalf of your patient with Medica prescription coverage.

Express Scripts offers ePA options.

If you are a Minnesota physician, please submit your patient's prior authorization request using the Minnesota State PA Request Form.

2020 Prior Authorization Requests

Commercial Large Group and Nebraska Farm Bureau Non-Specialty Prior Authorization Inquiries
Phone: 1-800-753-2851
Fax: 1-877-251-5896

Commercial Small Group Non-Specialty Prior Authorization Inquiries
Phone: 1-800-753-2851
Fax: 1-877-251-5896

IFB Non-Specialty Prior Authorization Inquiries
Phone: 1-800-753-2851
Fax: 1-877-251-5896

Combined Medicare and Minnesota Health Care Programs Non-Specialty Prior Authorization Inquiries 
Phone: 1-800-935-6103
Fax: 1-877-251-5896

Medicare Non-Specialty Prior Authorization Inquiries
Phone: 1-800-935-6103
Fax: 1-877-251-5896

Medicare Non-Specialty Prior Authorization Inquiries 
Phone: 1-800-935-6103
Fax: 1-877-251-5896

Minnesota Health Care Programs Non-Specialty Prior Authorization Inquiries
Phone: 1-800-753-2851
Fax: 1-877-251-5896

Date: 11/18/2019 7:33:08 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02