Prior Authorization Resources
Spend less time on prior authorizations, more time on patients.
Benefits of Electronic Prior Authorizations
Did you know that more than half of the prior authorizations we receive each month are electronic?
Now is a great time for you to make the switch to electronic prior authorization (ePA). Here’s why:
- Faster to send and get reviews
- Easier to use for prescribers, nurses and office staff
- Works for any prescription drug and any pharmacy
- Keeps all your ePA documentation and requests in one place
Other Prior Authorization Resources
If you’re unable to use electronic prior authorization, there are other ways to submit your PA request.
Call us at 800.753.2851, download a state specific fax form or fax your requests to the number shown on our general request form. For example, use the prior authorization general request form below if you would like to request a coverage determination (such as a step therapy exception) or if you would like to make an appeal for us to reconsider a coverage decision.
- See resources below for some state-specific forms and PA statistics
- Download Prior Authorization General Request Form (e.g., use this to initiate step therapy exception)
- Medicare Plan Members Coverage Review Information
Prior Authorization and Step Therapy Exception Resources
Please call us at 800.753.2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.
If you can't submit a request via telephone, please use our general request form or one of the state specific forms below and fax it to the number on the form. For example, use the general request form below if you would like to request a coverage determination (such as a step therapy exception) or if you would like to make an appeal for us to reconsider a coverage decision.
- Prior authorization general request form (e.g., use this to initiate step therapy exception)
- Prior Authorization form for physicians in Arkansas, Michigan, Oregon, and Vermont
- Arizona prior authorization forms
- California general form
- Colorado universal form
- Illinois required form
- Iowa general form
- Kansas general form
- Kansas Medicaid form
- Louisiana universal form
- Massachusetts general form
- Massachusetts oncology form
- Massachusetts Synagis form
- Massachusetts Hepatitis C form
- New Hampshire general form
- New York contraceptive exception request form
- New York standard prior authorization form
- Oklahoma general request form (including step therapy exceptions)
- Texas general form
For physicians requesting a Prior Authorization for patients with insurance through Blue Cross Blue Shield of Louisiana, please call 800.842.2015 or submit your request via fax using this form.
Prior Authorization Statistics
In an effort to promote transparency of its prior authorization programs, Express Scripts publishes the following approval and denial statistics.
Additional Resources
Our highly-effective, clinically-based NPF is an example of how we make the market work for payers and patients by leveraging competition and directing members to medications with the lowest net cost. The NPF provides access to nearly 4,000 medications.
For patients with an Express Scripts ID card or TRICARE beneficiaries, ePrescribe to:
Express Scripts Home Delivery NCPDP ID 2623735 4600 North Hanley Road St. Louis, MO 63134
For Workers' Compensation, ePrescribe to:
Workers’ Comp Express Scripts NCPDP ID 0320301 4600 North Hanley Road St. Louis MO 63134
ePrescribing questions?
Call 800.211.1456 or email ePrescribing@express-scripts.com.
If a qualifying medication is not right for your patient, you may be able to request an alternative medication to be covered at no cost to the patient. Please call Express Scripts at 1-800-753-2851 or fax a completed Benefit Coverage Request Form to 1-877-328-9660 to request a clinical review.