CareContinuum Medical Drug Benefit Management Program

The 1199SEIU Benefit Funds have partnered with CareContinuum, an Express Scripts company, to perform prior authorizations for certain medical drugs that providers may buy and bill the Benefit Funds for reimbursement. Starting January 1, 2014, all providers must contact CareContinuum for a prior authorization before administering these specialty drugs to their 1199SEIU patients. Providers may continue to pre-authorize specialty drugs that are dispensed by Accredo by contacting Express Scripts.

View the Medical Drug Benefit Management Program Specialty List

Providers can submit a prior authorization request to CareContinuum in one of several ways:

  • Online via CareContinuum’s ExpressPAth Portal at Online requests will receive a determination right away if the request is approved. Click here to download the ExpressPAth Quick Start Guide.
  • By calling (877) 273-2122, where a CareContinuum representative will be available to assist you Monday through Friday, 8:00 am to 7:00 pm EST.
  • By faxing a request to (877) 814-4047. Click here to download drug-specific Request for Prior Authorization fax forms. (Please note: Fax will not be available after April 1, 2015.)

Save Time! Submit Medication Prior Approval Requests Electronically

To streamline the review process for medications requiring prior approval under our pharmacy and medical benefits, the 1199SEIU National Benefit Fund is providing access to ExpressPAth, an online application that furnishes a quick and efficient response to these requests. ExpressPAth is an online tool used to manage a provider’s prior authorization (prior approval) requests. Use ExpressPAth instead of phoning or faxing your requests in order to save time in your office. In many cases, ExpressPAth will offer a real-time prior authorization approval, giving you an answer to your request in just minutes.

Providers should contact [email protected] to register for upcoming webinar training sessions, or to obtain access to ExpressPAth.