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Medications Requiring Prior Authorization Under the Medical Benefit

Posted 12/1/2020 at 9:19 AM

Ensure you remain current on the most recent changes

We’ve made changes to the list of medications requiring prior authorization under the Medical Benefit. 

As part of our policy, Healthfirst requires prior authorization for medical claims for all medications listed in this document when administered in an office or clinic setting.

Ways to Submit Prior Authorization:

  • Online via the Provider Portal at hfproviderportal.org – Log in to the Provider Portal, click on the “Online Authorization Request” tab, and then click “Begin”. Once member is identified, select “Outpatient” as Request Type, then select “Outpatient Pharmacy” as Authorization Type.
  • By calling Provider Services at 1-888-801-1660, Monday to Friday, 8:30am–5:30pm
  • By faxing 1-212-801-3223 (Note: DO NOT use for pharmacy benefit authorizations via CVS Caremark)

Check back frequently for the latest updates.