Prior Approval Form for Prescription Drugs[pdf] This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process.
For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception request questions, contact 501-378-3392.
Pharmacy claim search in My Blueprint Your prescription claims history, including prescription number, date
filled, prescriber, quantity, pharmacy, amount paid by you and amount paid
by your pharmacy plan. To access information about your personal pharmacy
claims, you must register to use My Blueprint, our member self-service
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