Pharmacy Prescription Specialty Drugs Prior Authorization Process Update – Effective 09/01/2026
Impacted LOBs: CHP, EP, QHP, Gold, GoldCare
TO: All Providers
Dear MetroPlusHealth Provider,
Effective as of September 1, 2026, Prior Authorization (PA) requests for Pharmacy Prescription Specialty Drugs for MetroPlusHealth Child Health Plus, Essential Plan, Marketplace QHP Plans, MetroPlusHealth Gold, and GoldCare Plans will be managed by CVS Caremark.
Providers should contact the CVS Specialty Team at 1.866.814.5506 for assistance with Specialty Drug PA requests, including submissions, status inquiries, approvals, denials, and clinical review questions.
To submit electronic prior authorization requests, providers may use the CVS Caremark ePA portal at Caremark Electronic Prior Authorization.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].
We appreciate your continued partnership in providing quality care to our members.
Thank you,
MetroPlusHealth