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Prior Authorization and Step Therapy Criteria

(For members using prescription drug benefits associated with CVS Caremark through their medical plan)

Provider assistance: 877-433-2973

Authorization request FAX: 888-487-9257

Clinical Criteria

Select the starting letter of the medication to find the desired form. Drug coverage is dependent on member’s formulary.

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A

Glossary list of letter A

B

Glossary list of letter B

C

Glossary list of letter C

D

Glossary list of letter D

E

Glossary list of letter E

F

Glossary list of letter F

G

Glossary list of letter G

H

Glossary list of letter H

I

Glossary list of letter I

J

Glossary list of letter J

K

Glossary list of letter K

L

Glossary list of letter L

M

Glossary list of letter M

N

Glossary list of letter N

O

Glossary list of letter O

P

Glossary list of letter P

Q

Glossary list of letter Q

R

Glossary list of letter R

S

Glossary list of letter S

T

Glossary list of letter T

U

Glossary list of letter U

V

Glossary list of letter V

W

Glossary list of letter W

X

Glossary list of letter X

Y

Glossary list of letter Y

Z

Glossary list of letter Z