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Medical specialty and pharmacy policies

For all AllWays Health Partners lines of business, certain medications require prior authorization. Search below to find a specific drug.

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Prior authorization information

 

Medications obtained through the medical benefit

Certain medications obtained through the medical benefit require prior authorization through Novologix (NLX).* A list of medications reviewed by NLX can be found here.

*Please note: This list is not inclusive of all medications that require prior authorization by AllWays Health Partners. This list is specific to medications reviewed by NLX only. For all other medical benefit medications, including those that are new-to-market, request authorization through AllWays Health Partners.

 

Please use the following information to submit an authorization:
  • Medical Benefit Medications (Novologix)

    All Plans   |  Phone: 844-345-2803   |  Fax: 844-851-0882

    Prior Authorization Form

     

    To submit a prior authorization please review the informational grid at the top of each criteria document for information regarding any program, benefit designation, and the contact information to submit your request.
  • Medical Benefit Medications (AllWays Health Partners)

    All Plans   |  Phone: 866-814-5506   |  Fax: 866-249-6155

    Prior Authorization Form

     

    To submit a prior authorization please review the informational grid at the top of each criteria document for information regarding any program, benefit designation, and the contact information to submit your request.

Medications obtained through the pharmacy benefit

Medications that require prior authorization through the pharmacy benefit, including those that are non-formulary, should be submitted to the appropriate CVS Caremark destination.

To find out if a medication requires prior authorization or if it is listed on our formulary* please search the drug look up tool.

*Please note: Medications not listed in the drug look up tool are considered non-formulary and require a medical necessity PA for coverage.

 

Please use the following information to submit an authorization:

Site of care – home infusion policy

For AllWays Health Partners members except My Care Family members and Partners Health Care employees, certain infusion therapy drugs must be administered in the home setting. View the list .

Requests for other sites of care will be approved only when it is medically necessary to be performed in a setting other than the home. Prior authorization is required through Novologix (NLX). View the policy.
 

Medical specialty and pharmacy drug policies

Questions about pharmacy guidelines?

Call provider services at 855-444-4647.

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