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
