• Formulario/Lista de medicamentos recetados para 2023 (PDF)
  
• CGM (Continuous Glucose Monitors) - FreeStyle Libre (Preferred)
• Suministros de recetas por un período extendido de 90 días (PDF)

 PA Formularios

• CoverMyMeds
• Formulario de solicitud de autorización previa para medicamentos no especializados - Retail Pharmacy (PDF)
• Medical Benefit - Buy And Bill Request (PDF)

New Century Health - Oncology

All oncology-related chemotherapeutic drugs and supportive agents will require prior authorization from New Century Health (NCH) before being administered in a physician’s office, outpatient hospital, or ambulatory setting.
This process applies to both Medical Benefit (Buy and Bill Request) AND Pharmacy Services (Retail Pharmacy)

Pre-Approval Process

The requesting physician must complete an authorization request using one of the following methods:

• Log in to the NCH Provider Web Portal at https://my.newcenturyhealth.com.
• Call 1-888-999-7713 and select option 1, from 8 a.m. to 8 p.m. EST, Monday through Friday. General New Century Health Information.
• New Century Health FAQ (PDF)