ICORE Healthcare

Prior Authorization

Prior Authorization is required for the following medications

Please select the name of the medication that you would like to obtain prior authorization for. Print the prior authorization form and then fax the completed form, along with supporting documentation, to ICORE at 888-656-2040.

If the medication you are looking for is not listed, please use the generic prior authorization form located here.

BlueChoice of SC providers should contact Caremark directly for any oral medication requests.

Please note: ICORE’s online pharmacy authorizations resource and generic prior authorization forms are for pharmacy distribution clients and not intended for use by ICORE’s Oncology Benefit Management (OBM) or Provider Administered Drug Program (PADP) clients. If you need to obtain a prior authorization for OBM or PADP, please use the Get an Authorization online tool or refer to the educational materials that were distributed for using the online tools.