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Preapproval Requirements

Preapproval reviews are conducted by
UniCare's Managed Care department, or by
Carelon Medical Benefits Management® or CarelonRx. Carelon Medical Benefits Management and CarelonRx are UniCare-affiliated
companies that provide support for the preapproval process.

In addition, some specialty drugs require review and dispensing by CVS Caremark, the prescription drug administrator for UniCare’s non-Medicare members. 

Services That Require Preapproval

The Provider Reference Sheet identifies which services are reviewed by UniCare, which are reviewed by Carelon Medical Benefits Management or CarelonRx, and how much notice is required. The reference sheet also includes information about member copays, notification requirements for preapprovals, and selected procedures for pre-review.

CVS Caremark Site-of-Care Specialty Drug List

Preapprovals for Specialty Drugs (non-oncology)

Preapprovals for Specialty Drugs (oncology)

Preapprovals for Genetic Testing

For more information, refer to our member handbooks for plan benefits, conditions, limitations and exclusions.
 

How to Request Preapproval

UniCare Managed Care

Contact UniCare’s Managed Care Department at 800-442-9300

Carelon Medical Benefits Management

UniCare's partnership with Carelon Medical Benefits Management lets our providers use Carelon Medical Benefits Management's web-based application for services reviewed by Carelon Medical Benefits Management. Providers can log into the Carelon Medical Benefits Management application and complete the intake. In many cases, the entire review and approval process can be done online. Providers who already use Carelon Medical Benefits Management's web application will not have to re-register for UniCare.

Carelon Medical Benefits Management reviews: Contact them directly through the Carelon Medical Benefits Management web application or call 866-766-0247

CarelonRx

Expanded review is required for certain infused specialty drugs. If a non-Medicare member will be getting infusions of certain non-oncology specialty drugs in a hospital outpatient setting, an expanded review will be conducted to review both the drug for clinical appropriateness and the level of care/site of service.

CarelonRx reviews for certain non-oncology specialty drugs (non-Medicare members only): 833 293 0659; covermymeds.com/main/prior-authorization-forms

CVS Caremark

CVS Caremark, the prescription drug administrator for non-Medicare members, covers and dispenses self- or office-administered specialty drugs. Some of these specialty drugs require review and dispensing by CVS Caremark.

CVS Caremark reviews of other specialty drugs (non-Medicare members only): 877-876-7214 caremark.com