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 Medicare Advantage Plan Coverage
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.
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.
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:
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.
- Anti-Rejection Drugs, Immunosuppressants
- ESRD/Dialysis-Related Drugs
- Immune Globulins
- Infusion/Injectable Drugs
- Nebulized Medications
- Oral Anti-Emetic Drugs
- Oral Chemotherapy Agents
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.
The Prescriber Portal allows providers to access claim status, member eligibility, and claim submission options.
We’re here to help.