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Insurance Plans - Pennsylvania
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
AMERICAN PROGRESSIVE LIFE AND HEALTH INS CO NY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
AMERICHOICE OF PENNSYLVANIA, INC
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
AMERIGROUP TEXAS, INC.
AVALON HEALTH, LTD
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
CAPITAL ADVANTAGE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number
E-mail Address: Not Available
Updated: May 2006
ELDER HEALTH OF PA, INC.
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number
E-mail Address: Not Available
Updated: May 2006
GATEWAY HEALTH PLAN, INC.
GEISINGER HEALTH PLAN
Where to Get Forms: Call 1-800-554-3907 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-544-3907 option 2
Phone # to request Exception: Not Available
Fax #: Call 1-800-554-3907 and ask for fax number.
E-mail Address: CMS.PartD@argushealth.com
Updated: May 2006
HEALTH ASSURANCE PENNSYLVANIA, INC.
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number
E-mail Address: Not Available
Updated: May 2006
HEALTH PARTNERS OF PHILADELPHIA INC
Where to Get Forms: Call 215-991-4300 and ask to have form faxed.
Phone # to request Prior Authorization: 215-991-4300
Phone # to request Exception: Not Available
Fax #: 215-849-2150
E-mail Address: Not Available
Updated: May 2006
HEALTHAMERICA PENNSYLVANIA, INC.
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number
E-mail Address: Not Available
Updated: May 2006
HIGHMARK SENIOR RESOURCES INC.
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
HUMANA HEALTH PLAN, INC.
INDEPENDENCE BLUE CROSS
KEYSTONE HEALTH PLAN CENTRAL,INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
KEYSTONE HEALTH PLAN EAST, INC.
KEYSTONE HEALTH PLAN WEST, INC.
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
MARQUETTE NATIONAL LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEMBERHEALTH, INC.
PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
PENNSYLVANIA LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
QCC INS CO D/B/A AMERIHEALTH INS CO
RXAMERICA, LLC
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: lois.mastin@rxamerica.com
Updated: May 2006
SILVERSCRIPT INSURANCE COMPANY
STERLING LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available
Updated: May 2006
THREE RIVERS HEALTH PLANS, INC.
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: roger.hadden@rxamerica.com
Updated: May 2006
UNICARE
UNITED AMERICAN INSURANCE COMPANY
Where to Get Forms: Your pharmacist will receive information from the plan
if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information
from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6650 and ask to have form sent.
Phone # to request Prior Authorization: 1-877-665-6650
Phone # to request Exception: 1-800-207-2609
Fax #: 1-866-617-6726
E-mail Address: provider.relations@walgreens.com
Updated: May 2006
UNIVERSITY OF PITTSBURGH MEDICAL CENTER
UPMC HEALTH NETWORK
WELLCARE HEALTH PLANS
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