CVS Health® provides the info on the next page. Aetna® is part of the CVS Health family of companies. If you want to stay on our site, choose the “X” in the upper right corner to close this message. Or choose “Go on” to move forward to CVS.com.
Pharmacy prior authorization (PA)
When a medication isn't on the preferred drug list (PDL), or has a utilization management requirement, you’ll want to request pharmacy PA. Take a minute to review our current guidelines.
Getting started
Getting started
You’ll need to include the criteria for the drug that you’re requesting PA for. You can visit the Vendor Drug Program’s page for more info about guidelines, including:
- Clinical edits for covered drugs
- Drugs requiring PA
- PA criteria logic
- Supporting tables, references and publication history
Electronic PA (ePA)
Electronic PA (ePA)
You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request pharmacy PA with our ePA program.
With ePA, you can look forward to saving time with:
- Less paperwork
- Fewer phone calls and faxes
- Quicker determinations
- Safe and secure HIPAA-compliant submitted requests
Enroll now
Getting started with ePA is free and easy. You’ll need this info to enroll:
- BIN: 610591
- PCN: ADV
- Group: RX8801
You can enroll two different ways:
You can enroll with CoverMyMeds online. Or call 1-866-452-5017.
You can enroll with Surescripts online. Or call 1-866-797-3239.
Other ways to request PA
If you don’t want to enroll in ePA, you can request PA:
By phone
You can request PA when you contact us.
By fax
You can download and print the Texas Standard Prior Authorization Form (PDF). Then, fax it with any supporting documentation for a medical necessity review to 1-844-275-1084.
Emergency requests
Federal and Texas state laws require pharmacists to give members their medication without delay after a 72-hour emergency claim.
Note: PA requests received by phone will have an immediate approval or denial decision. All other PA requests (urgent and standard) will
receive a decision from us within 24 hours.
You can learn more by visiting our Non-pharmacy prior authorization or Utilization management pages.
Non-pharmacy prior authorization