Pharmacy Authorization Forms
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Prior Authorization Forms A - O
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Click "ctrl + f" and type in the name of the drug to search.
Common Formulary Prior Authorization Request Form
Aetna's Universal Pharmacy Prior Authorization Fax Form
Opioids and MME (opioid naive member for more than a 7-day supply of preferred and non-preferred agents)
Opioids Long-acting and Transdermal (non-preferred agents)
Opioids Short and Intermediate Acting (non-preferred agents)
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Prior Authorization Forms P - Z
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Click "ctrl + f" and type in the name of the drug to search.
Common Formulary Prior Authorization Request Form
Aetna's Universal Pharmacy Prior Authorization Fax Form
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Electronic Prior Authorization (ePA)
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We are committed to making sure our providers receive the best possible information, and the latest technology and tools available.
We have partnered with CoverMyMeds® and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program.
With Electronic Prior Authorization (ePA), you can look forward to:
- Time saving
- Decreasing paperwork, phone calls and faxes for requests for prior authorization
- Quicker Determinations
- Reduces average wait times, resolution often within minutes
- Accommodating & Secure
- HIPAA compliant via electronically submitted requests
No cost required! Let us help get you started!
Getting started is easy. Choose ways to enroll:
- Visit the CoverMyMeds® website
- Call CoverMyMeds® toll-free at 866-452-5017
- Visit the SureScripts website
- Call SureScripts toll-free at 866-797-3239
Billing Information:
BIN: 610591
PCN: ADV
Group: RX8826