Submitting a prior authorization request

To simplify your experience with prior authorization and save time, please submit your prior authorization request to your pharmacy benefit manager through any of the following online portals:

Prior authorization via fax

Prior authorization is one of your pharmacy benefit manager's utilization management procedures. It requires that providers receive approval from the pharmacy benefit manager before prescribing certain medications. This safeguard ensures that the drug prescribed is clinically appropriate for the plan participant and encourages the use of generic or lower-cost brand-name drugs as an alternative. Prior authorization also ensures that drugs prescribed for off-label use are done so in accordance with U.S. Food and Drug Administration guidelines.

• Commercial prior authorization forms
  • Select formulary
  • Premium formulary
  • Value formulary
     
• Medicare Part D forms
  • Med Part D formulary