Applies for Prior Authorization, Step Therapy Requests and Formulary Exceptions
Medica requires prior authorization or step therapy for certain drugs administered under a Medica member's pharmacy benefit. This program is administered by Express Scripts®. When a prior authorization is needed for a prescription, the member will be asked to have the physician, or authorized agent of the physician, contact Express Scripts's Prior Authorization Department to answer criteria questions to determine coverage.
Prior authorization, step therapy and formulary exception requests may be submitted for review. Included below is the information you need to submit a request on behalf of your patient with Medica prescription coverage.
Express Scripts offers ePA options. Click here to get started
General Express Scripts Drug Coverage & Exception Request Form (PDF)
If you are a Minnesota physician, please submit your patient's prior authorization request using the Minnesota uniform form for prescription drug prior authorization (PA) requests, step therapy (ST) requests and formulary exceptions .
If you are an Arizona provider, use this form (pages 2-3) to submit prior authorization requests for medications starting January 1, 2023.