Prior Authorization

With electronic prior authorization (ePA), spend more time with patients and less time phoning and faxing.

ExpressPath           CoverMyMeds

(Not compatible with TRICARE beneficiaries)

 

We’re excited to announce that Express Scripts is now transitioning from faxed to electronic prior authorizations. Express Scripts is proud to lead the way for faster, easier, and more efficient communications with physicians by maximizing electronic channels wherever possible.

If you’re already using ePA through ExpressPAth®, Surescripts®, CoverMyMeds®, or your EHR, continue to use the tool that works best for your office.

 

ExpressPAth®

ExpressPAth is a user-friendly, web-based prior authorization system across the medical and pharmacy benefit. With it, you can manage pharmacy prior authorizations for your patients with Express Scripts pharmacy benefits (as indicated on the patient’s prescription card). You can also manage medical prior authorizations if your patient’s health plan is part of Care Continuum*

What Providers Need to Expedite Patient Care 

 

Electronic Health Records

Using your Electronic Health Record (EHR) is the fastest way to complete an ePA and is the best tool if you’re already ePrescribing regularly. Reach out to your Office Manager, Medical Director, or EHR vendor to make sure you have the latest software version upgraded with ePA. Need a phone number or link for your EHR? Click here for contact information for the most common vendors.

 

CoverMyMeds®

Over 700,000 providers choose CoverMyMeds for their ePA needs. Express Scripts has partnered with CoverMyMeds to offer free ePA services for all Express Scripts patients. Also, CoverMyMeds is the preferred ePA solution for those servicing TRICARE beneficiaries.

 

Want to Learn More about ePA?

Click here for a list of the most common questions and answers.

 

State Specific Information

EPA is a streamlined process that decreases turnaround time for Prior Authorizations, minimizes gaps in patient care, and is Express Scripts’ preferred method to receive PA submissions.

However, mandates exist in some states requiring Express Scripts to offer fax as an available option for submitting prior authorization requests. Click here for more state specific information.

 

Prior authorization and  coverage review requests

For more information on specific plan types and Medicare Prescription Plan Resources, visit this page.

 

*Care Continuum will be listed on the health plan card if medical PA through ExpressPAth is an option.