- EFT Payments Issued as Checks:CareFirst identified on or around May 10 an issue in which some providers who were set up to receive ACH/EFT payments instead received paper checks. This issue remains under active investigation. Providers do not need to take any action at this time. We are working toward resolution and will continue to share updates as more information becomes available, including expected timing.
- ERAs Reflecting Check Information Instead of ACH:CareFirst is aware of an issue in which some Electronic Remittance Advices (ERAs) reflected check payment information instead of ACH/EFT details. This issue was resolved on May 29, 2026. CareFirst is currently working to reissue impacted ERAs to include the correct ACH/EFT information. Providers do not need to take any action at this time.
- PreAuth/Provider Portal/CFD applications will be unavailable Sat,July 18 from 8AM to 2PM and Sun, July 19 from 8AM to 2PM
Prior Authorization
Certain medications require prior authorization to ensure safe and effective use. The drug policies listed below include criteria for prior authorization, site of care, quantity limits, and/or step therapy. They are subject to the terms of a member’s specific health plan.
The drug policies are broken out by drugs covered under the medical benefit or pharmacy benefit:
- Medical benefit: Typically, medications covered under the medical benefit are administered in an outpatient hospital, home or office setting.
- Pharmacy benefit: Typically, medications covered under the pharmacy benefit are oral, topical or inhaled products distributed by retail or mail pharmacies.
Specialty drugs may be covered either through the medical and/or pharmacy benefit. A full list of drugs that have prior authorization and/or site of care requirements under the medical benefit can be found on our pharmacy resources page.
How to Submit a Drug Prior Authorization
Prior authorization requests for drugs covered under the medical benefit must be submitted electronically through the CareFirst Provider Portal . To submit a prior authorization request online, log in to the Provider Portal and navigate to the Prior Auth/Notifications tab. For more information, please complete our Medication Prior Authorization training.
If you are experiencing technical difficulties with the Provider Portal, please contact the CareFirst Help Desk at 877-526-8390.
Prior Authorization Documents & Policies
To access all medical and pharmacy benefit policies and prior authorization fax forms, please visit the CVS Caremark* Prior Authorization Documents page.
Please note that you will be leaving the CareFirst site when you click the blue button below. You will be routed to a website owned by CVS Caremark and subject to CVS Caremark’s Privacy Policy and Terms and Conditions.
CVS Prior Authorization Documents
For questions about a prior authorization covered under the medical benefit, please contact CVS Caremark* at 888-877-0518.
For questions about a prior authorization covered under the pharmacy benefit, please contact CVS Caremark* at 855-582-2038.
For questions about FEP members and their prior authorization, please access this FEP list of medications for online prior authorization entry of call 800-469-7556.
*CVS Caremark is an independent company that provides pharmacy benefit management services.