Electronic Prior Authorizations

Providers may use SureScripts, CoverMyMeds, or ExpressPath as Prior Authorization Portals, which makes it easy for to submit fully electronic prior authorization requests right away. There is no EHR needed, no technology integration, and no cost to providers — just quick and easy electronic prior authorizations. Please confirm that the member has updated their address on file with Wellfleet prior to submission to avoid any denials due to missing address information.


As an alternative to an electronic submission, you may complete a  Prior Authorization Request Form to request a prior authorization. The Prior Authorization Request Form is to be used by providers to obtain coverage for a formulary drug requiring prior authorization (PA), a non-formulary drug for which there is no suitable alternative available, or any overrides of pharmacy management procedures such as step therapy, quantity limit or other edits. The form can be completed an faxed to (877) 251-5896.  Alternatively, a prior authorization request may be initiated by calling (877) 640-7938 with the information requested in the form.

If you are looking for a state-specific prior authorization request form not listed below, additional forms can be found here: State-Specific PA Forms »

Copyright 2023 © All rights Reserved. Wellfleet

Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.

Products, documents and materials provided by Wellfleet including the material contained therein, are proprietary to Wellfleet Group, LLC and protected by applicable copyright or trade secrets laws. Information contained within may not be published, distributed, or reproduced, in part or whole, without express written consent of Wellfleet Group, LLC.