How to Fax a Medication Prior Authorization to Express Scripts
Express Scripts is a pharmacy benefit manager, so the prior authorizations it reviews are coverage determinations for medications rather than for surgeries or imaging. When a drug needs approval under the pharmacy benefit, the prescriber's office faxes a completed coverage-determination request with the clinical rationale. This guide covers preparing that drug-specific request, finding the fax line matched to the medication, and keeping proof of the send.
Does Express Scripts accept a fax?
Express Scripts accepts medication prior authorization and coverage-determination requests by fax, and it often publishes a drug-specific form whose fax number is tied to that medication or therapeutic class. Because Express Scripts manages the pharmacy benefit, the accepting line is set by the drug being requested, not by a general medical-review number.
Finding the official fax number
The correct fax number is printed on the Express Scripts coverage-determination form for the specific medication and on the prescriber resources where that drug's criteria are published. The member's pharmacy benefit documents and any coverage-denial letter also state where the request goes, so confirm the number on the drug-specific form each time rather than reusing a saved one.
What to include on every page
- The member's name, date of birth, and Express Scripts member or Rx ID number
- The prescriber's name, NPI, DEA where relevant, and a fax for the coverage decision
- The exact drug, strength, dosage form, and directions being requested
- The diagnosis (ICD-10) and documented prior therapies the drug's criteria require
- A cover sheet naming the member and the medication and flagging any urgency
How to fax Prior Authorization Request Form to Express Scripts
- 1Complete the Express Scripts coverage-determination form for the specific medication
- 2Attach the clinical notes and prior-therapy history the drug's criteria require
- 3Confirm the current fax number on that drug-specific Express Scripts form
- 4Merge the form and supporting records into one clear, readable PDF
- 5Open Send FAX Mail, upload the PDF, enter the confirmed fax number, and send
- 6Save the delivery confirmation with the patient record to log the submission date
Confirming it arrived
Send FAX Mail returns a dated receipt once the request reaches the Express Scripts fax line — keep it with the prescription record. Express Scripts communicates the coverage decision back to the prescriber and member, and the receipt shows exactly when the drug request was submitted if a determination timeline is later questioned.
What’s current · as of July 2026
- HIPAA large-breach reporting threshold
- 500+ individuals — reported to HHS OCR without unreasonable delay Source: HHS Office for Civil Rights
- HIPAA documentation retention period
- 6 years from creation or last-effective date Source: HHS — HIPAA Administrative Requirements (45 CFR 164.316)
Recent updates
Federal interoperability rules keep pushing healthcare past the fax machine
CMS has advanced a series of interoperability rules that press hospitals, payers, and providers toward electronic data exchange and standardized claims attachments. The direction of travel is clear: paper and analog fax workflows are being replaced by digital transmission that carries an auditable record — which is exactly what a cloud fax with delivery confirmation provides for offices not yet on a full EHR pipeline.
CMS →Healthcare breach reporting keeps document handling under scrutiny
Ongoing reporting on HIPAA breaches and OCR settlements underscores how much scrutiny falls on how medical documents are stored, sent, and received. Sending records through a controlled, access-logged channel rather than an unmanaged machine reduces the mishandling risks that show up repeatedly in breach analyses.
HIPAA Journal →HHS OCR continues enforcing HIPAA safeguards on how PHI is transmitted
The HHS Office for Civil Rights enforces the HIPAA Security Rule's requirement that covered entities apply administrative, physical, and technical safeguards to protected health information in transit. Faxing PHI is permitted, but the sending practice is responsible for confirming the destination and controlling access — the reason healthcare senders favor a channel that logs each transmission and its recipient.
HHS Office for Civil Rights →
Faxing Prior Authorization Request Form to Express Scripts — FAQ
Express Scripts administers the pharmacy benefit as a PBM, so its reviews decide whether a specific medication is covered under that benefit. A request for surgery or imaging goes to the member's medical plan instead; what Express Scripts evaluates is the drug, its criteria, and the clinical justification for it.
Each drug or therapeutic class typically has its own Express Scripts coverage-determination form, and the fax line is printed on that form. Pull the number from the form matching the exact medication being requested, since a different drug's form may direct the request to a different review queue.
Yes. Express Scripts supports electronic prior authorization through prescriber ePA services such as CoverMyMeds and SureScripts, which many offices prefer for speed. Faxing the completed form stays a valid alternative, especially when the supporting chart notes are already scanned into one document.
Standard coverage determinations run on a set timeframe, while an expedited review — for cases where a delay could seriously harm the member — moves faster. Provide the clinical reason for urgency on the request so it is worked on the shorter clock; otherwise it follows the standard pharmacy-benefit timeline.
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