Absolute Total Care has a team of doctors and pharmacists who create tools to help us offer benefits to our members. Some of the tools are listed and described below:
- Prior Authorization: We require you to get approval from us before we agree to cover certain drugs. We call this prior authorization. If you don’t get approval, you may be asked to pay for the drug.
- Age Limits: Some drugs require approval if your age does not meet what is advised by the Food and Drug Administration (FDA) or clinical recommendations.
- Quantity Limits: Some drugs limit the number of pills for a specific number of days.
- Step Therapy: Some drugs require you to try a less expensive drug before “stepping up” to drugs that cost more.
You can ask Absolute Total Care to make an exception to our coverage rules.
We must decide within 72 hours of getting the note and form from your doctor. You or your doctor can request an expedited (fast) exception if your health is in danger. If the request for a fast exception is allowed, we must tell you our decision within 24 hours of getting the note and form from your doctor.
(*Please note: You cannot use this form for Medicare non-covered drugs: fertility drugs, drugs prescribed for weight loss, weight gain or hair growth, over the counter drugs, or prescription vitamins - except prenatal vitamins and fluoride preparations.)
Call Absolute Total Care for the most recent list of covered drugs. Please call Member Services at 1-855-735-4398. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.