Medical Drug Preauthorization
These drugs are covered under the medical benefit only.
DAKOTACARE members: Providers can initiate preauthorization requests by faxing the appropriate form and documentation to 1-605-274-3279 or send a secure email to pharmacy@DAKOTACARE.com.
DAKOTACARE Administrative Services members: Chemotherapy preauthorizations must be submitted online at www.connect.eviti.com; all other preauthorization requests should be faxed to 1-605-274-3279 with the appropriate form and clinical documentation.
NOTE: Not all plans cover these drugs nor require preauthorization. Please refer to the member’s policy (also known as the Master Contract) for information regarding coverage determination.
***This list does not guarantee coverage and is subject to change.***