Medical specialty and pharmacy policies

IMPORTANT COVID-19 INFORMATION: During the COVID-19 public health emergency, some of our medical specialty and pharmacy policies may be superseded by the information on our COVID-19 FAQ.

Prior authorization information

Medications obtained through the medical benefit

Most medications covered on the medical benefit require prior authorization through Novologix (NLX). Click here for a list of the medications authorized by Novologix*

Helpful information

Read our authorization process for off label medical specialty medication requests.
For new-to-market, request authorization through Novologix (NLX). Reference the new-to-market drug policy for more information.
For out of network providers, requesting service for a non-PPO member, request authorization through AllWays Health Partners.

*Please note: This list is not inclusive of all medications that require prior authorization by AllWays Health Partners. This list is specific to covered medications reviewed by NLX only.

How to submit authorizations to NovoLogix
Online:  Access the NovoLogix online prior authorization tool through the provider portal
Phone: 844-345-2803  |  Fax: 844-851-0882

Standard Prior Authorization Form  | Standard Oncology Prior Authorization Form*

*Please note: For Commercial/Exchange members - Requests for medications used for the treatment of Cancer, including supporting medications, must be submitted on the Standard Oncology Prior Authorization Form.
Check the top of the criteria document for additional information, including program details, benefit designation, and contact information.
How to submit authorizations to AllWays Health Partners
Providers who are outside of AllWays Health Partners provider network, requesting service for a non-PPO member, can submit requests online through the online authorization submission form

Medications obtained through the pharmacy benefit

For medications covered on the pharmacy benefit, please submit prior authorizations through CVS Caremark using the information below.

To find out if a medication requires prior authorization or if it is listed on our formulary* please search the drug look up tool.

*Please note: Medications not listed in the drug look up tool are considered non-formulary and require a medical necessity prior authorization for coverage.

Specialty Medications
Phone: 866-814-5506 | Fax: 866-249-6155
Standard Prior Authorization Form | Standard Hepatitis C Prior Authorization Form | Standard Synagis Prior Authorization Form | Standard Oncology Prior Authorization Form*

*Please note: For Commercial/Exchange members - Requests for medications used for the treatment of Cancer, including supporting medications, must be submitted on the Standard Oncology Prior Authorization Form.

Check the top of the criteria document for additional information, including program details, benefit designation, and contact information
Non-Specialty Medications
Commercial   | Phone: 800-294-5979   | Fax: 888-836-0730
Health Connector   | Phone: 855-582-2022   | Fax: 855-245-2134
MassHealth   | Phone: 877-433-7643   | Fax: 866-255-7569

Standard Prior Authorization Form

Check the top of the criteria document for additional information, including program details, benefit designation, and contact information

Site of care – home infusion policy

For AllWays Health Partners members, except My Care Family and Massachusetts General Brigham employees, drugs on this list must be administered in the home setting.

To request other, medically necessary sites of care, please submit a prior authorization through NovoLogix. View the policy.

Medical specialty and pharmacy drug policies

Questions about pharmacy guidelines?

Call provider services at 855-444-4647.

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