Prior Authorization Requests for the Pharmacy and Medical Benefit

February 2021

ePA for the Pharmacy Benefit

Electronic Prior Authorization (ePA) is a fully electronic solution that processes requests for prior authorizations (PA), Step Therapy, and Quantity Limit exceptions at a near real-time decision, allowing patients to start therapy sooner.

ePA is easily accessible through a web-based portal, such as Covermymeds, or may be integrated into your Electronic Health Record (EHR) platform.

ePA is easy to use and decreases administrative burden by reducing the back and forth between provider offices and Neighborhood. Providers answer a drug-specific PA question set and attach relevant documents, lab results, and/or provider notes, if necessary.

  • Eliminate hand-written faxed PA requests!

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eForm for the Medical Benefit

The Neighborhood Pharmacy department created an electronic form (eForm) to allow providers to submit requests electronically via our Neighborhood Pharmacy Provider Resources Webpage for Medical Benefit Requests.

 eForm provides an alternative to manually faxing Prior Authorization requests for medical benefit drugs and minimizes administrative burden.

  • This solution does not replace ePA through Covermymeds for pharmacy benefit requests. 

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