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Pharmacy Prior Authorization*

Drug Prior Authorization

Prior authorization requests must be submitted electronically through the CareFirst Provider Portal for all drugs requiring prior authorization.

If you are already using the CareFirst Provider Portal, login at www.carefirst.com/providerlogin, and click on the Prior Auth/Notifications tab to begin your request. If you are not yet registered to use the Provider Portal, you can do so at www.carefirst.com/carefirstdirect.

Questions?

If you are experiencing technical difficulties with the Provider Portal, please contact the CareFirst Help Desk at 877-526-8390.

For all other questions regarding the submission of your request, please contact CVS Caremark:

  • For specialty drugs: 888-877-0518
  • For non-specialty drugs: 855-582-2038
  • For FEP drugs requiring online prior authorization: 800-469-7556

Pharmacy Prior Authorization

5 HI1 Agonist Post Limit
Abilify®
Abilify® (For Maryland Only)
Abraxane®
Abraxane® (For Maryland Only)
Abstral®
Accu-Chek Aviva Plus Test Strips
Accu-Chek Strips and Kits 4
Accu-Chek Strips and Kits 4 (For Maryland Only)
Acetemra®
Acetemra® (For Maryland Only)
Actimmune®
Actimmune® (For Maryland Only)
Actiq®
Actos
Actos (For Maryland Only)
Adagen®
Adcirca®
Adderall XR
Adderall XR (For Maryland Only)
Adempas®
Adrenaclick®
Adrenaclick® (For Maryland Only)
Advicor®
Advicor® (For Maryland Only)
Aerospan®
Aerospan® (For Maryland Only)
Afinitor®
Afinitor® (For Maryland Only)
Aldurazyme®
Alecensa®
Alimta®
Alimta® (For Maryland Only)
Alphanate®, Humate-P®, Koate-DVI®, Wilate®
Alphanate®, Humate-P®, Koate-DVI®, Wilate® (For Maryland Only)
Alsuma®
Altoprev®
Altoprev® (For Maryland Only)
Alvesco®
Alvesco® (For Maryland Only)
Amerge®, Imitrex®, Maxalt®, Zomig® Post Limit
Amitiza®
Amitiza® (For Maryland Only)
Ampyra®
Ampyra® (For Maryland Only)
Amrix®
Amrix® (For Maryland Only)
Androdgel®
Androdgel® (For Maryland Only)
Angiotensin II Receptor Antagonists Combo FA-EXC®
Angiotensin II Receptor Antagonists Combo FA-EXC® (For Maryland Only)
Angiotensin II Receptor Antagonists FA-EXC®
Angiotensin II Receptor Antagonists FA-EXC® (For Maryland Only)
Apexicon E FA-EXC®
Apexicon E FA-EXC® (For Maryland Only)
Apidra FA-EXC®
Apidra FA-EXC® (For Maryland Only)
Arthrotec FA-EXC®
Arthrotec FA-EXC® (For Maryland Only)
Asacol-HD FA-EXC®
Asacol-HD FA-EXC® (For Maryland Only)
AAT Deficiency
Atacand®
Atacand® (For Maryland Only)
Atacand® HCT
Atacand® HCT (For Maryland Only)
Apokyn®
Aranesp®
Arcalyst®
Aubagio®
Aubagio® (For Maryland Only)
Avastin®
Avastin® (For Maryland Only)
Avonex®
Avonex® (For Maryland Only)
Beconase AQ®
Beconase AQ® (For Maryland Only)
Benefix®, Alphanine SD®, Bebulin®, Profilnine®, Mononine®, Rixubis®, Alprolix®
Benlysta®
Benlysta® (For Maryland Only)
Berinert-Cinryze®
Betaseron®
Betaseron® (For Maryland Only)
Blincyto®
Biguanides (FA-EXC)®
Biguanides (FA-EXC)® (For Maryland Only)
Bosulif®
Bosulif® (For Maryland Only)
Botox®, Dysport®, Xeomin®
Botox®, Dysport®, Xeomin® (For Maryland Only)
Breeze 2 Test Strips (FA-EXC)®
Breeze 2 Test Strips (FA-EXC)® (For Maryland Only)
Bydureon®
Bydureon® (For Maryland Only)
Byetta (FA-EXC)®
Byetta (FA-EXC)® (For Maryland Only)
Buphenyl®
Butorphanol®
Carac®
Carac® (For Maryland Only)
Cardizem®
Cardizem® (For Maryland Only)
Cardizem® CD
Cardizem® CD (For Maryland Only)
Cardizem® LA
Cardizem® LA (For Maryland Only)
Caprelsa®
Caprelsa® (For Maryland Only)
Carbaglu®
Cayston®
Cerezyme®, VPRIV®
Cholbam®
Cialis®
Cimzia®
Cimzia® (For Maryland Only)
Clobetasol® Spray
Clobetasol® Spray (For Maryland Only)
Clobex® Spray
Clobex® Spray (For Maryland Only)
Compound Drug Products
Cometriq®
Contour Test Strips
Contour Next Test Strips amd Kits 4
Contour Next Test Strips amd Kits 4 (For Maryland Only)
Contour Strips amd Kits 4
Contour Strips amd Kits 4 (For Maryland Only)
Copaxone
Copaxone (For Maryland Only)
Corifact®
Cosentyx®
Cosentyx® (For Maryland Only)
Cotellic®
Cymbalta®
Cymbalta® (For Maryland Only)
Cystagon®
Cystaran®
Cytogam®
Delzicol®
Delzicol® (For Maryland Only)
Detrol LA, Oxytrol, Toviaz (FA-EXC)®
Detrol LA, Oxytrol, Toviaz (FA-EXC)® (For Maryland Only)
Diabetic Test Strips – Atypical (FA-PA)
Diovan®
Diovan® (For Maryland Only)
Diovan® HCT
Diovan® HCT (For Maryland Only)
Docetaxel®
Docetaxel® (For Maryland Only)
DPP-4 Inhibitors Combinations (FA-EXC)®
DPP-4 Inhibitors Combinations (FA-EXC)® (For Maryland Only)
DPP-4 Inhibitors (FA-EXC)®
DPP-4 Inhibitors (FA-EXC)® (For Maryland Only)
Duexis (FA-EXC)®
Duexis (FA-EXC)® (For Maryland Only)
Dymista (FA-EXC)®
Dymista (FA-EXC)® (For Maryland Only)
Edarbi®
Edarbi® (For Maryland Only)
Edarbyclor®
Edarbyclor® (For Maryland Only)
Egrifta®
Enbrel®
Enbrel® (For Maryland Only)
Entresto
Entyvio®
Entyvio® (For Maryland Only)
Elaprase®
Elelyso®
Eligard®
Eloctate®
Eloctate® (For Maryland Only)
Eloxatin®
Eloxatin® (For Maryland Only)
Epogen®, Procrit®
Erbitux®
Erbitux® (For Maryland Only)
Erivedge®
Esbriet®
Exforge®
Exforge® (For Maryland Only)
Exforge® HCT
Exforge® HCT (For Maryland Only)
Exjade®
Exjade®, Jadenu®
Extavia®
Extavia® (For Maryland Only)
Eylea®
Fabior®
Fabrazyme®
Farxiga (FA-EXC)®
Farxiga (FA-EXC)® (For Maryland Only)
Farydak®
Farydak® (For Maryland Only)
Feiba®
Fentora®
Ferriprox®
Firazyr®
Firmagon®
Flector (FA-EXC)®
Flector (FA-EXC)® (For Maryland Only)
Flolan®, Veletri®, epoprostenol
Fluorouracil® Cream 0.5%
Fluorouracil® Cream 0.5% (For Maryland Only)
Freestyle Test Strips
Forteo®
Forteo® (For Maryland Only)
Fortament®
Fortament® (For Maryland Only)
Fortesta®
Fortesta® (For Maryland Only)
Fosrenol®
Fosrenol® (For Maryland Only)
Freestyle Strips and Kits 4®
Freestyle Strips and Kits 4® (For Maryland Only)
Frova Post Limit®
Fuzeon®
GamaSTAN S/D®
GamaSTAN S/D® (For Maryland Only)
Gattex®
Gemzar®
Gemzar® (For Maryland Only)
Gilenya®
Gilenya® (For Maryland Only)
Gilotrif®
Glatopa®
Glatopa® (For Maryland Only)
Gleevec®
Glumetza®
Glumetza® (For Maryland Only)
Growth Hormone
Growth Hormone (For Maryland Only)
Advate®, Helixate FS®, Hemofil M®, Kogenate FS®, Monoclate-P®, Recombinate®, Xyntha®
Advate®, Helixate FS®, Hemofil M®, Kogenate FS®, Monoclate-P®, Recombinate®, Xyntha® (For Maryland Only)
H.P. Acthar Gel®
H.P. Acthar Gel® (For Maryland Only)
Hecoria (FA-EXC)®
Hecoria (FA-EXC)® (For Maryland Only)
Hepatitis C®
Hepatitis C® (For Maryland Only)
Hetlioz®
Hereditary Angioedema
Herceptin®
Herceptin® (For Maryland Only)
Hizentra®
HMG-CoA Reductase Inhibitors (FA-EXC)®
HMG-CoA Reductase Inhibitors (FA-EXC)® (For Maryland Only)
Humalog (FA-EXC)®
Humalog (FA-EXC)® (For Maryland Only)
Humalog Mix 50/60) (FA-EXC)®
Humalog Mix 50/60)(FA-EXC)® (For Maryland Only)
Humalog Mix 75/25) (FA-EXC)®
Humalog Mix 75/25)(FA-EXC)® (For Maryland Only)
Humira®
Humira® (For Maryland Only)
Humulin 70/30 (FA-EXC)®
Humulin 70/30 (FA-EXC)® (For Maryland Only)
Humulin N (FA-EXC)®
Humulin N (FA-EXC)® (For Maryland Only)
Humulin R (FA-EXC)®
Humulin R (FA-EXC)® (For Maryland Only)
Hycamtin®
HyQvia®
Ibrance®
Iclusig®
Ilaris®
Ilaris® (For Maryland Only)
Imbruvica®
Imbruvica® (For Maryland Only)
Incruse Ellipta®
Incruse Ellipta® (For Maryland Only)
Infertility Therapy
Influenza Treatment
Inlyta®
Inlyta® (For Maryland Only)
Insomnia Agents (FA-EXC)
Insomnia Agents (FA-EXC)(For Maryland Only)
Intermezzo®
Intermezzo® (For Maryland Only)
Intron A®
Intron A® (For Maryland Only)
Intuniv®
Intuniv® (For Maryland Only)
Invokamet®
Invokamet® (For Maryland Only)
Invokana®
Invokana® (For Maryland Only)
IVIG®
IVIG® (For Maryland Only)
Ixempra®
Jakafi®
Jakafi® (For Maryland Only)
Jalyn (FA-EXC)®
Jalyn (FA-EXC)® (For Maryland Only)
Juxtapid®, Kynamro®
Juxtapid®, Kynamro® (For Maryland Only)
Kadcyla®
Kadcyla® (For Maryland Only)
Kalbitor®
Kalydeco®
Kazano®
Kazano® (For Maryland Only)
Kineret®
Korlym®
Komibiglyze XR®
Komibiglyze XR® (For Maryland Only)
Kuvan®
Lastacaft (FA-EXC)®
Lastacaft (FA-EXC)® (For Maryland Only)
Lazanda®
Lemtrada®
Lemtrada® (For Maryland Only)
Lenvima®
Lenvima® (For Maryland Only)
Lescol XL®
Lescol XL® (For Maryland Only)
Letairis®
Levitra (FA-EXC)®
Levitra (FA-EXC)® (For Maryland Only)
Lipitor®
Lipitor® (For Maryland Only)
Liptruzet®
Liptruzet® (For Maryland Only)
Livalo®
Livalo® (For Maryland Only)
Lucentis®, Macugen®
Lumigan (FA-EXC)®
Lumigan (FA-EXC)® (For Maryland Only)
Lumizyme®, Myozyme®
Lunesta®
Lunesta® (For Maryland Only)
Lupron®, Hormonal
Leukine®
Lynparza®
Lynparza® (For Maryland Only)
Matzim LA®
Matzim LA® (For Maryland Only)
Mekinist®
Mekinist® (For Maryland Only)
Mircera®
Mitoxantrone®
Multiple Sclerosis Drugs
Multiple Sclerosis Drugs (For Maryland Only)
Myalept®
Myobloc®
Naglazyme®
Naprelan (FA-EXC)®
Naprelan (FA-EXC)® (For Maryland Only)
Nasal Steroids (FA-EXC)®
Nasal Steroids (FA-EXC)® (For Maryland Only)
Natpara®
Natesto®
Natesto® (For Maryland Only)
Nesina®
Nesina® (For Maryland Only)
Neulasta®
Neumega®
Neupogen, Granix, Zarxio®
New to Market Drugs;
New to Market Drugs (For Maryland Only)
Ninlaro®
Northera®
Noritate®
Noritate® (For Maryland Only)
Nesina® (For Maryland Only)
Nexavar®
Nexavar® (For Maryland Only)
NovoSeven RT®
NovoSeven RT® (For Maryland Only)
Norvasc (FA-EXC)®
Norvasc (FA-EXC)® (For Maryland Only)
Nplate®, Promacta®
Nplate®, Promacta® (For Maryland Only)
Ofev®
Oleptro
Oleptro (For Maryland Only)
Olux-E (FA-EXC)
Olux-E (FA-EXC) (For Maryland Only)
Omanaris
Omanaris (For Maryland Only)
Omega 3 Fatty Acids
Omntrope
Omntrope (For Maryland Only)
Onglyza
Onglyza (For Maryland Only)
Onsolis®
Opsumit®
Oral Pain Meds
Orencia®
Orencia® (For Maryland Only)
Orenitram®
Orkambi®
Oseni
Oseni (For Maryland Only)
Osteoarthritis Agents (FA-EXC)®
Osteoarthritis Agents (FA-EXC)® (For Maryland Only)
Orfadin®
Otezla®
Otezla® (For Maryland Only)
Otrexup®, Rasuvo®
Otrexup®, Rasuvo® (For Maryland Only)
Oxycontin® Post Limit
Oxytrol
Oxytrol (For Maryland Only)
Pennsaid
Pennsaid (For Maryland Only)
Perjeta®
Perjeta® (For Maryland Only)
Plavix
Plavix (For Maryland Only)
Plegridy®
Plegridy® (For Maryland Only)
Pomalyst®
Praluent®
Prevacid
Prevacid
Prevacid (For Maryland Only)
Procysbi®
Procysbi® (For Maryland Only)
Prolia®
Prolia® (For Maryland Only)
Protonix
Protonix (For Maryland Only)
Proton Pump Inhibitors (FA-EXC)®
Proton Pump Inhibitors (FA-EXC)® (Fort Maryland Only)
Provenge® (For Maryland Only)
Provenge®
Proventil® HFA
Proventil® HFA (For Maryland Only)
Pulmozyme®
QNSL® HFA
QNSL® HFA (For Maryland Only)
QSYMIA® HFA
QSYMIA® HFA (For Maryland Only)
Ravicti®
Ravicti® (For Maryland Only)
Rayos (FA-EXC)®
Rayos (FA-EXC)® (For Maryland Only)
Reclast®
Reclast® (For Maryland Only)
Relistor®
Relistor® (For Maryland Only)
Remicade®
Remicade® (For Maryland Only)
Remodulin®
Replax Post Limit®
Revatio®
Revlimid®
Revlimid® (For Maryland Only)
Rebif (FA-EXC)®
Rebif (FA-EXC)® (For Maryland Only)
Rhinocort Aquia®
Rhinocort Aquia® (For Maryland Only)
RiaSTAP®
Riomet®
Riomet® (For Maryland Only)
Rituxan®
Rituxan® (For Maryland Only)
Rozerem®
Rozerem® (For Maryland Only)
Ruconest®
SABAs (FA-EXC)®
SABAs (FA-EXC)® (For Maryland only)
Sabril®
Sabril® (For Maryland Only)
Samsca®
Sandostatin®
Sandostatin® (For Maryland Only)
Serostim®
Serostim® (For Maryland Only)
Sensipar®
Signifor®
Simponi®, Simponi Aria®
Simponi®, Simponi Aria® (For Maryland Only)
Soliris®
Solodyn®
Solodyn® (For Maryland Only)
Solodyn Step Therapy (Brand Only)®
Somatuline Depot®
Somavert®
Somavert® (For Maryland Only)
Sprycel®
Stelara®
Stelara® (For Maryland Only)
Strensiq®
Stimate®
Stivarga®
Stivarga® (For Maryland Only)
Subsys®
Sutent®
Sutent® (For Maryland Only)
Sylatron®
Symbicort (FA-EXC)®
Symbicort (FA-EXC)® (For Maryland Only)
Synagis®
Tafinlar®
Tamiflu Post Limit®
Tarceva®
Tarceva® (For Maryland Only)
Targretin®
Tasigna®
Tasigna® (For Maryland Only)
Tagrisso®
Tazorac®
Tecfidera®
Tecfidera® (For Maryland Only)
Temodar®
Testim®
Testim® (For Maryland Only)
Testosterone Gel 1% 5
Testosterone Gel 1% 5 (For Maryland Only)
Testosterone Products (FA-EXC)
Testosterone Products (FA-EXC) (For Maryland Only)
Teveten®
Teveten® (For Maryland Only)
Teveten® HCT
Teveten® HCT (For Maryland Only)
Tev-Tropin®
Tev-Tropin® (For Maryland Only)
Thalomid®
Thalomid® (For Maryland Only)
Tikosyn®
TOBI®, Bethkis®
Toviaz®
Toviaz® (For Maryland Only)
Tracleer®
Treanda®
Treanda® (For Maryland Only)
Trelstar®
Tretten®
Tretinoin Products®
Treximet Post Limit®
Tricor (FA-EXC)®
Tricor (FA-EXC)® (For Maryland Only)
Trentinoins
Tudorza
Tudorza (For Maryland Only)
Tykerb®
Tykerb® (For Maryland Only)
Tysabri®
Tysabri® (For Maryland Only)
Tyvaso®
Uptravi®
Valchlor®
Valchlor® (For Maryland Only)
Valcyte
Valcyte (For Maryland Only)
Valtrex (FA-EXC)®
Valtrex (FA-EXC)® (For Maryland Only)
Vantas®
Velcade®
Velcade® (For Maryland Only)
Ventavis®
Ventonlin® HFA
Ventonlin® HFA (For Maryland Only)
Veramyst®
Veramyst® (For Maryland Only)
Viagra®
Viagra® (For Maryland Only)
Vidaza®
Vimizim®
Vimovo (FA-EXC)®
Vimovo (FA-EXC)® (For Maryland Only)
Visudyne®
Vogelxo®
Vogelxo® (For Maryland Only)
Votrient®
Votrient® (For Maryland Only)
Xalkori®
Xeljanz®
Xeljanz® (For Maryland Only)
Xeloda®
Xeloda® (For Maryland Only)
Xenazine®
Xgeva®
Xgeva® (For Maryland Only)
Xifaxan®
Xolair®
Xolair® (For Maryland Only)
Xopenex® HFA
Xopenex® HFA (For Maryland Only)
Xtandi®
Yervoy®
Zavesca®
Zelboraf®
Zetonna®
Zetonna® (For Maryland Only)
Zoladex®
Zometa®, Zoledronic Acid®
Zolinza®
Zorbtive®
Zubsolv®
Zubsolv® (For Maryland Only)
Zydelig®
Zydelig® (For Maryland Only)
Zykadia®
Zykadia® (For Maryland Only)
Zytiga®