Prior Authorization Criteria Form - Caremark 2026

1. Click ‘Get Form’ to open the Prior Authorization Criteria Form - Caremark in our platform.
2. Begin by filling out the 'Patient Information' section. Enter the patient's name, ID, group number, date of birth, and phone number accurately.
3. Next, complete the 'Prescribing Physician' section. Provide the physician's name, phone number, fax number, address, city, state, and zip code.
4. In the 'Drug Name' field, specify the medication being prescribed along with its quantity, route of administration, frequency, strength, and expected length of therapy.
5. Answer the diagnostic questions by circling 'Y' for Yes or 'N' for No. Ensure you provide accurate responses as they determine further processing.
6. Finally, review all information for accuracy before signing and dating the form at the bottom. Once completed, fax it to CVS/Caremark at 1-888-836-0730.

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