

All other plans have different Rx benefits than Keystone 65 Complete.
If you are interested in another plan, go to Prior Authorization for all plans.
When a member presents a prescription at a participating network pharmacy, the pharmacy is informed, using the claims processing point-of-service system. If the requested drug is either non-formulary or requires prior authorization, the pharmacy then notifies the member, contacts the prescribing physician, and/or contacts PerformRx to determine the appropriate course of action.
In order to obtain a prior authorization for a medication, these steps should be followed:
Providers who would like to submit a prior authorization request, may either contact our provider help desk at 1-888-684-5502, or use our prior authorization request form. Please answer all questions on the form and fax to the phone number listed on the form. A request form must be completed for all medications requiring prior authorization. The forms below are available in PDF format. The forms for the current prior authorization medications are:
General Pharmacy Prior Authorization Form
Members wishing to check on the status of a prior authorization request submitted by their doctor should contact our member services department.
Members call toll free 1-888-457-3108 (TTY/TDD#: 1-888-857-4816) 8 a.m. to 8 p.m., seven days a week.
Providers wishing to check on the status of a prior authorization request they have submitted should contact our provider help desk.
Providers call toll free 1-800-684-5502.