Preauthorization - How it works
Certain drugs require preauthorization, based on criteria established and approved by ConnectiCare's Pharmacy and Therapeutics Committee. Some drugs within the preauthorization program require other medications be used prior to approval. This is called step therapy.
Preauthorization requests must be faxed to ConnectiCare’s Pharmacy Services Department at 1-800-249-1367 by the prescribing physician’s office.
When submitting a request for preauthorization please use the appropriate pharmacy preauthorization form.
What happens next?
- ConnectiCare’s pharmacist will review the request for authorization and make the determination.
- If the prescribed drug is approved, the prescription will be filled at a participating pharmacy or administered by a provider (where appropriate). Many drugs that require preauthorization must be filled by a specialty pharmacy.
- When a request for authorization is denied, ConnectiCare will notify the physician in writing, including: the reason for the determination and clinical rationale, if any; instructions on how to initiate an appeal of the decision; and, notice of the availability of clinical review criteria referenced in the decision.
Note: POS members receiving out-of-network care are responsible for initiating this process.