A reminder of our processes for submitting drug coverage authorization requests and appeals

To help providers better understand our processes for submitting drug coverage authorization requests and appeals, we’ve added the following information to the Drug Information page of the Provider Manual.

For pharmacy drugs:

All pharmacy drug coverage authorization requests, reconsiderations and appeals should be submitted to the Pharmacy department through one of the following methods:

• Fax: Send completed fax forms to 877.974.4411
• Electronic prior authorization (ePA)
• Phone: Call 800.466.6642
• Mail (For Medicare appeals only)
  Mail to: Priority Health Appeals Coordinator - MS12601
  231 East Beltline Ave NE Grand Rapids, MI 49525

Submitting pharmacy drug authorization requests or appeals through prism could lead to longer response times from our teams.

For medical drugs:

If the drug is listed on our Medical Benefit Drug List (MBDL), drug coverage authorization requests, reconsiderations and appeals should be submitted to the Pharmacy department through one of the methods listed above.

If the drug isn’t listed on our MBDL, drug coverage authorization requests, reconsiderations and appeals should be submitted through prism.