Pharmacy Authorization Forms
Prior Authorization Forms A - O
Click "ctrl + f" and type in the name of the drug to search.
Biologic Immunomodulators Updated 12.10.2020
Emflaza Updated 12.15.2020
Endari Updated 01.01.2021
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)
Prior Authorization Forms P - Z
Electronic Prior Authorization (ePA)
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