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Paramount's Pharmacy Benefit Manager is CVS/caremark! Click here for more information. All Mail Order will be handled through CVS/caremark.

Medicaid Pharmacy Providers: Maximum Allowable Cost (MAC) pricing appeals may be submitted through CVS/caremark. Please see the full appeals process here.

Please fax all Prior Authorization requests for Paramount Commercial, Advantage and Marketplace members toll free to 1-844-256-2025. Prior Authorization forms can be found here.

Prescription Drug Benefits

When prescribing medications, you want your patients to have access to the safest, highest quality medications available. As a health care provider, you also want to make sure that drugs are cost-effective. Paramount’s Prescription Drug Program is designed to ensure that our prescription benefit is both clinically effective and affordable for members.

The Prescription Drug Program is maintained by a team of pharmacists and physicians (the Pharmacy and Therapeutics Working Group) whose job is to approve clinical prescribing programs and drug formularies. Cost-effective, rigorously tested generic drugs are the cornerstone of the drug formulary. For drugs that lack a good generic alternative, our Pharmacy and Therapeutics Working Group chooses preferred brands that we provide for our members at a less costly rate. This system allows us to help you prescribe the best medicine available for the lowest possible cost. Learn more about our copay structure and Preferred Drugs.

Here are some additional facts about our Prescription Drug Program:

  • Drug benefits are available in three of our commercial product lines (HMO, PPO, CDHP benefits; Medicare Part D plans; and Medicaid Rx).  Learn more about Commercial Drug Benefits offered by Paramount.
  • Our pharmacy benefits are currently managed by CVS/caremark. Mail order medications are received through CVS/caremark as well.
  • Paramount’s Prescription Drug Program includes our Specialty Drug Program. Through the Specialty Drug Program, your patients have access to costly or difficult-to-obtain drugs from a trusted specialty network of hospitals, pharmacies and mail order. Learn more about Specialty Drugs.
  • We have implemented prior authorization and step therapy policies as an administrative safeguard for prescribing certain risky, new, or costly medications. Learn more about our Prior Authorization and Step Therapy policy.

If you have questions about a patient’s Paramount prescription benefit, please feel free to call the Provider Inquiry Department at 419-887-2564 or 888-891-2564. We can also answer questions through your Provider Direct e-mail, Monday - Friday from 8 a.m. - 12 p.m. and 1 p.m. - 5 p.m.

For questions about Paramount protocols and administrative issues, please contact the Provider Relations Department at 419-887-2535 or 800-891-2542. To reach Provider Relations at our Michigan office, just call 866-299-8620.