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Pharmacy prior authorization (PA)

When a medication isn't on our formulary (drug list) or has a utilization management requirement, you’ll want to request pharmacy PA. Take a minute to review our current guidelines.

Pharmacy PA guidelines

Learn more

You can check your provider manual (PDF). Or call us at 1-866-827-2710 (TTY: 711).

Electronic PA (ePA)

Electronic PA (ePA)

You'll need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program. 


With ePA, you can look forward to saving time with:


  • Less paperwork

  • Fewer phone calls and faxes

  • Quicker determinations

  • Safe and secure HIPAA-compliant submitted requests

Enroll now

Getting started with ePA is free and easy. You’ll need this info to enroll:


  • BIN: 610591

  • GRP: rx8817 

  • PCN: ADV

You can enroll two different ways:

Other ways to request PA


If you don’t want to enroll in ePA, you can request PA:

By phone

You can request PA by calling us at 1-866-827-2710 (TTY: 711).

By fax

Check “Request forms” below to find the right form. Then, fax it with any supporting documentation for a medical necessity review to 1-877-270-3298.

Request forms

If you don’t see the right form in the list, you can use the universal pharmacy request form (PDF). Otherwise, check for the drug class or drug name that matches your needs:

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