Regulatory Reports
- State of NJ Risk Class Statistics
- State of NJ Risk Reason Statistics
- State of NJ Risk Therapy Statistics
Request for Peer-to-Peer Discussion:
If the prescriber would like to discuss a prior authorization determination with a clinical peer, please contact the CVS Caremark Prior Authorization Department toll-free at 1-800-294-5979 and we will arrange to make a clinician available for discussion.
Prior Authorization Criteria
Select the starting letter of the medication to find the desired form. Drug coverage is dependent on member’s formulary.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
State-Specific Criteria
- Continuity of Care (DC, NJ)
- Continuity of Care (GA)
- Continuity of Care (CO, IL, MS, TN, VT, WY)
- Elective Termination of Pregnancy Agents Long List-Exceptions (GA)
- Elective Termination of Pregnancy Agents Long List-Exceptions (KY)
- Global Step Therapy (GA)
- Global Step Therapy (IL)
- Global Post Step Therapy (KY)
- Global Step Therapy (TN)
- Nutritional Supplements - Inborn Errors of Metabolism (KY)
- Universal States Mandate PANDAS-PAN (IL)
- Universal States Mandate Stage IV Cancer (GA and IL)