Provider Pharmacy Resources
Prior Authorization Form
Electronic Pharmacy Prior Authorizations: Fast, Free, and Easy
True Health New Mexico offers an electronic prior authorization (PA) option for providers who submit pharmacy PAs. Electronic PAs can reduce the amount of paperwork you have to do, can cut down on phone calls, and may provide you with faster responses. You also can track the status of your electronic PAs.
We have partnered with CoverMyMeds for electronic pharmacy PAs. Download the user guide here and learn more at https://www.covermymeds.com/main/support/provider/.
Medications Covered Under Medical Benefits vs. Under Pharmacy Benefit
Some medications are covered under our medical benefit, while others are covered under our pharmacy benefit. Member cost-share may be different based on which benefit is used. While not all-inclusive, this comparative list will help educate you about the differences between the two classifications.
Examples of drugs covered under the True Health New Mexico medical and pharmacy benefits
Medications Included in Site-of-Care Program
Below is a link to the list of drugs currently included in the Site-of-Care program and that must be provided by Optum Infusion Services. These infused drugs also require prior authorization for use.
Opioid Management Program
True Health New Mexico members are subject to the CVS/Caremark Opioid Management program. This program limits the dose/quantity of opioids that members can receive. If a member exceeds the limitations, prior authorization is required.
In general, prior authorization can be satisfied by providing a copy of the member’s current treatment plan, a risk assessment evaluation, and a copy of the member’s opioid contract. Prescribers may also attest to use of these specific tools.
Prescribers should fax prior authorization requests for opioids to True Health New Mexico Pharmacy Services at 1-866-718-7938.
Below are several resources to help True Health New Mexico providers manage their patients who are taking opioids. True Health New Mexico providers are not required to use these resources; they are offered as a convenience.