Provider Resources

Supporting the Providers Who Support Our Members

Thank you for visiting our Provider Resource page. This area is designed to assist you with quickly finding information regarding the SlateRx Pharmacy Benefit Management Program. We are committed to improving our member and provider service offerings and welcome your feedback, suggestions, and concerns.

Coverage Determination and Prior Authorization

Help manage costs, control misuse and protect patient safety to ensure the best possible therapeutic outcomes.

PromptPA

SureScripts

CoverMyMeds

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Non Formulary Exception Form

Prior Authorization Request Form

Quantity Limit Exception Form

Step Therapy Exception Form

Provider Specific Resources

If you are a participating pharmacy or provider with feedback or questions related to pharmacy network participation or would like to submit a pricing appeal, complaint or dispute, please contact SlateRx at ProviderRelations@Slate-Rx.com or 1-888-915-9135.

If you are a participating pharmacy or provider with feedback, questions or a complaint related to SlateRx benefits, eligibility, or formulary information, please contact SlateRx at Legal@Slate-Rx.com or 1-888-915-9135.

To complete our online prescriber survey, please click here.

SlateRx Clinical Services Department

Phone Number: 833-320-1824

Hours of Operation: Monday – Friday 9am-9pm ET; Saturday & Sunday 9am-1pm ET

Coverage Determination Fax Number: 866-351-1617

Appeal Fax Number: 866-306-4892

Address to Send Appeals:

SlateRx

Attn: Appeals Department
P.O. Box 608
Hudson, OH 44236

SlateRx Drug Lists

The following are lists of the most commonly prescribed medications. They represent an abbreviated version of the drug list (formulary) that is at the core of each prescription-drug benefit plan. These lists are not all-inclusive and do not guarantee coverage. In addition to drugs on these lists, the majority of generic medications are covered and members are encouraged to ask their doctor to prescribe generic drugs whenever appropriate. Visit optumrx.com for specific member coverage.

State-Specific Resources

Iowa

Prescription Medication Coverage Request Form

Tennessee

Initial Appeals Process (Reimbursement) 0780-01-95

The initial appeal process is available for all prescription drugs or devices in Tennessee for which a pharmacy alleges it did not receive its actual cost. The pharmacy must file an initial appeal within seven (7) business days of claim submission for reimbursement. Upon receipt of all required information, SlateRx will review and make a final determination within (7) seven business days. If SlateRx fails to comply with applicable timing and notice requirements, initial appeal shall be resolved in favor of the pharmacy. If a pharmacy fails to comply with applicable timing requirements, SlateRx may deny the initial appeal. Pharmacy is required to submit the name and contact information of the wholesaler or manufacturer from which the pharmacy purchased the drug or medical product or device.

TN Pharmacy Reimbursement Appeal Form can be found here.

In-Network Provider NADAC Reports

Georgia

Quarterly NADAC Reports: Georgia

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