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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.

CCA Medicare Advantage Plans Coverage

CCA Medicare Maximum 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.

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:

CCA RI Outpatient Medications Process

An outline of CCA MA’s outpatient medications process.

Coverage Determination

For some drugs, you will need to get approval (“prior authorization”) from CCA Health 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 Rhode Island – Prescription Drug Coverage Determination Request Form

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 provider have the right to appeal our decision.

CCA Health 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

Prescriber Portal

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

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