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Specialty pharmacy drugs

Specialty drugs for Mercy Care Advantage members need prior authorization (PA). You can ask for PA to administer a specialty drug either under a member's Medicare Part D or Medicare Part B coverage depending on their diagnosis and administration of the drug.

PA for Part D specialty drugs

You can ask for PA under a member’s Part D benefit:

By fax: Print and complete the coverage determination request form (PDF). Then, fax it with any supporting documentation to 1-855-230-5544. 
By phone: Call us at 602-586-1730 or 1-877-436-5288 (TTY 711). Choose option 2 for providers. Then, choose option 1 to initiate a coverage determination request.

PA for Part B specialty drugs

You can ask for PA under a member’s Part B benefit:

By fax: Fax your PA request with supporting documentation to 1-800-217-9345.
By phone: Call 602-586-1730 or 1-877-436-5288 to initiate an organization determination (PA) for the specialty medication.

Part B versus Part D coverage rules

You can learn more about Part B versus Part D coverage rules. Just check Appendix C, Chapter 6 of the Medicare Prescription Drug Manual (PDF).

Questions?

Check your provider manual or contact us.