Provider Resources - Physician

At IngenioRx, we value our relationships with providers. We know that your time is valuable so this page is designed to direct you to the tools and resources that help you serve your patients.

 

Table of Contents

Prior Authorizations/Exception Requests
Formulary Management
Utilization Management
Prescribing Instructions for IngenioRx Home Delivery and Specialty Pharmacies

Prior Authorizations/Exception Requests

Prior authorizations (PA) play an important role in maximizing the clinical benefit of pharmacy care, minimizing patient exposure to unnecessary health risk, and reducing waste. Our electronic prior authorization (ePA) process through CoverMyMeds is the preferred method to submit PA and exception requests.

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If you are experiencing technical difficulties with submitting an electronic prior authorization, you can call us at 833-293-0659 to submit a verbal prior authorization. Our prior authorization team is available from 8 a.m. – 9 p.m. EST Monday – Friday and Saturday from 10 a.m. to 2 p.m. EST. If you cannot submit requests to the IngenioRx prior authorization department through ePA or telephone, you can fax us your request at 844-521-6940.

If you have questions about our utilization management policies or need to speak to someone about a prior authorization/exception request, please call us at 833-293-0659 from 8 a.m. to 9 p.m. EST Monday – Friday and Saturday from 10 a.m. to 2 p.m. EST.

Formulary Management

An independent group of practicing doctors, pharmacists and other health-care professionals on the P&T Committee meet often to look at new and existing drugs. They choose drugs for our formulary based on a number of factors including how well they work, value to patients and safety. All drugs on our formulary are approved by the Food and Drug Administration (FDA).

By using a member’s formulary as an input to prescribing decisions, providers can maximize the clinical benefit of pharmacy care, avoid clinically inferior drugs, minimize patient exposure to unnecessary health risk, and reduce waste.

Our four-tier National formulary is our most widely adopted formulary. You can find a copy of our four-tier National formulary here. A list of recent updates to the formulary can be found here.

If you have questions about the formulary of a specific member, you can access the Real Benefit Check tool in your electronic medical record (EMR) platform to view specific drug information.

Utilization Management

Qualified licensed health professionals assess the clinical information submitted to support Utilization Management (UM) decisions. IngenioRx as the responsible organization for UM affirms that decisions are based only on appropriateness of care and service and existence of coverage.

The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization or create barriers to care and service.

Prescribing Instructions for IngenioRx Home Delivery and Specialty Pharmacies

Our preferred way to accept prescriptions for IngenioRx Home Delivery Pharmacy is through ePrescribing. To send IngenioRx Home Delivery Pharmacy an electronic prescription, please search for IngenioRx Home Delivery Pharmacy in your ePrescribing platform. Alternatively, you can call us at 833-203-1742 or fax the prescription to 800-378-0323.

Our preferred way to accept prescriptions for IngenioRx Specialty Pharmacy is through ePrescribing. To send IngenioRx Specialty Pharmacy an electronic prescription, please search for IngenioRx Specialty Pharmacy in your ePrescribing platform. Alternatively, you can call us at 833-262-1726 or fax the prescription to 833-263-2871.