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Specialty pharmacy drugs

Specialty drugs for Mercy Care Advantage members need prior authorization (PA). You can ask for PA to administer a specialty drug either under a member's Medicare Part D or Medicare Part B coverage depending on their diagnosis and administration of the drug.

PA for Part D specialty drugs

You can ask for PA under a member’s Part D benefit: 

 

PA for Part B specialty drugs

You can ask for PA under a member’s Part B benefit:  

  • By fax: Fax your PA request with supporting documentation to 1-800-217-9345.
  • By phone: Call 602-586-1730 or 1-877-436-5288 to initiate an organization determination (PA) for the specialty medication.  
 

Part B versus Part D coverage rules

You can learn more about Part B versus Part D coverage rules. Just check Appendix C, Chapter 6 of the Medicare Prescription Drug Manual (PDF).

Questions?

Check your provider manual or contact us