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Pharmacy prior authorization (PA)

When a medication isn't on our formulary, or has a utilization management requirement, you’ll want to request pharmacy PA. You can review our current guidelines.

Learn more

Provider manual (PDF)


Or give us a call at 1-800-279-1878 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 6 PM.

Electronic PA (ePA)

Electronic PA (ePA)

You 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

  • Easy upload of clinical documents

Enroll now

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


  • BIN: 610591
  • GRP: RX8837
  • 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

Give us a call at 1-800-279-1878 (TTY: 711).

By fax

Check the “PA request forms” section below to find the right form. Then, fax it with any supporting documentation for a medical necessity review to 1-855-799-2553.

Request forms

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

Learn more about PA


Non-pharmacy PA

CoverMyMeds is a registered trademark of CoverMyMeds LLC.

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