Pharmacy Information

Search for Covered Drugs

CCA covers a wide range of both over-the-counter, brand-name and generic prescription drugs at no cost to you. Find out if a medication is covered under your plan and what to do when it’s not.

CCA MassHealth Plans Coverage

CCA One Care (Medicare-Medicaid Plan) and CCA Senior Care Options (HMO D-SNP)

CCA One Care

CCA Senior Care Options

CCA Medicare Advantage Plan Coverage

CCA Medicare Preferred (PPO) and CCA Medicare Value (PPO)

CCA Medicare Advantage Plans

Real-time Benefit Tool

What’s my out-of-pocket expense? Click below to check up-to-date medication costs at your pharmacy of choice.

Price My Medication¹

Outpatient Medications

Prior authorizations (PA) for certain drug prescriptions help ensure all necessary clinical criteria are met for coverage. The process for submitting a prior authorization may differ depending on several factors.

The main consideration is the medication:

Type of medication.
How the medication is administered.
Where the medication is administered.

CCA MA Outpatient Medications Process

An outline of CCA MA’s outpatient medications process.

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English PDF

Coverage Determination

For some drugs, you will need to get approval (“prior authorization”) from Commonwealth Care Alliance before we can agree to cover a drug for your patient. The requirement for getting approval in advance may also help to guide appropriate use of certain drugs. If you do not get this approval, your patient’s drug might not be covered by the plan.

CCA Massachusetts – Prescription Drug Coverage Determination Request Form

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English PDF | Updated 10/12/2021

Submit Prior Authorization Form Online

Submit a prior authorization request for prescription drug coverage determination online, or through mail or fax using the form below:

Online Prior Authorization Form

Medicare Part B vs. D Forms

Prior authorization is required to determine appropriate coverage under Medicare Part B or Part D.

Medicare Part B vs. D coverage determination requests can be initiated via phone or the form may be sent via fax or mail:

Phone Number: (866) 270-3877

Fax Number: (855) 668-8552

Mailing Address: ATTN: PRIOR AUTHORIZATION

P.O. Box 1039

Appleton, WI 54912-1039

Provider must ensure proper clinical information is submitted with the coverage determination request.

Navitus Health Solutions will review your request and make a determination as to whether the request meets the requirements for approval. The decisions for standard requests are made no later than 72 hours from when we received the request. If waiting 72 hours could potentially jeopardize a patient’s health, providers can send an expedited request for the patient, in which case a decision will be issued within 24 hours. For all expedited requests, providers must include a statement that they confirm that this request should be escalated.

If the request is denied, patients or their providers have the right to appeal our decision.

CCA Redetermination Form

If your request for coverage for a prescription drug was denied, you have the right to ask for an appeal of our decision within 60 days of the Notice of Denial.

Drug Coverage Redetermination Form

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English PDF | Updated 1/13/2021

Prescriber Portal

The Prescriber Portal allows providers to access claim status, member eligibility, and claim submission options.

Need more information?
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Search for Covered Drugs

CCA covers a wide range of both over-the-counter, brand-name and generic prescription drugs at no cost to you. Find out if a medication is covered under your plan and what to do when it’s not.