Express scripts formulary exception form

Spend less time on prior authorizations, more time on patients.

Benefits of Electronic Prior Authorizations

Did you know that more than half of the prior authorizations we receive each month are electronic?

Now is a great time for you to make the switch to electronic prior authorization (ePA). Here’s why:

• Faster to send and get reviews
• Easier to use for prescribers, nurses and office staff
• Works for any prescription drug and any pharmacy
• Keeps all your ePA documentation and requests in one place

The EviCore ® by Evernorth portal lets you manage prescription drug ePAs for patients with Express Scripts pharmacy benefits. This also gives the convenience of managing your medical prior authorization needs with EviCore ® .

Connect to all PBMs and payers with ePA from Surescripts ® . It’s easy to submit ePA requests and you can save valuable time if you haven’t fully integrated ePA into your electronic health record workflow.

CoverMyMeds ® is a one-stop solution that works for all medications and all payers.

The ExpressPAth ® portal lets you manage prescription drug ePAs for patients with Express Scripts pharmacy benefits, or if your patient’s health plan is part of Care Continuum. Not available for TRICARE ® beneficiaries.

Other Prior Authorization Resources

If you’re unable to use electronic prior authorization, there are other ways to submit your PA request.

Call us at 800.753.2851, download a state specific fax form or fax your requests to the number shown on our general request form. For example, use the prior authorization general request form below if you would like to request a coverage determination (such as a step therapy exception) or if you would like to make an appeal for us to reconsider a coverage decision.

• See resources below for some state-specific forms and PA statistics
• Download Prior Authorization General Request Form (e.g., use this to initiate step therapy exception)
• Medicare Plan Members Coverage Review Information

Prior Authorization and Step Therapy Exception Resources

Please call us at 800.753.2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

If you can't submit a request via telephone, please use our general request form or one of the state specific forms below and fax it to the number on the form. For example, use the general request form below if you would like to request a coverage determination (such as a step therapy exception) or if you would like to make an appeal for us to reconsider a coverage decision.

• Prior authorization general request form (e.g., use this to initiate step therapy exception)
• Prior Authorization form for physicians in Arkansas, Michigan, Oregon, and Vermont
• Arizona prior authorization forms
• California general form
• Colorado universal form
• Illinois required form
• Iowa general form
• Kansas general form
• Kansas Medicaid form
• Louisiana universal form
• Massachusetts general form
• Massachusetts oncology form
• Massachusetts Synagis form
• Massachusetts Hepatitis C form
• New Hampshire general form
• New York contraceptive exception request form
• New York standard prior authorization form
• Oklahoma general request form (including step therapy exceptions)
• Texas general form

For physicians requesting a Prior Authorization for patients with insurance through Blue Cross Blue Shield of Louisiana, please call 800.842.2015 or submit your request via fax using this form.

Prior Authorization Statistics

In an effort to promote transparency of its prior authorization programs, Express Scripts publishes the following approval and denial statistics.

• 2020 Arkansas Preauthorization Statistics
• 2021 Arkansas Preauthorization Statistics
• 2022 Arkansas Preauthorization Statistics
• 2023 Arkansas Preauthorization Statistics
• 2024 Arkansas Preauthorization Statistics
• 2022 Georgia Preauthorization Statistics