1. Select Form
Forms can be found be selecting the pharmacy network tab. Recent request types will also appear on the front page. There are two main request types:
- Prior Authorization
- Financial Assistance
2. Complete Form
Each form will require some basic information (patient name, DOB, prescriber, pharmacy).
- Drug Specific Form - Medical records are not required, but highly recommended to be submitted with the request.
- General Form - Some type of documentation will be required with the request.
