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Prior Authorization
There are two ways a request can be created:
Select his option if you would like to create a request for:
- Prior Authorization
- Appeals
- Drug Specific Form - These forms will ask you a few questions about the drug. Completion of this form makes it more likely your request will be reviewed accurately and quickly. It is highly recommended to complete this form where available.
- General Form - Can be used for any drug, but does not ask any drug specific questions.
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Financial Assistance
Each form will require some basic information (patient name, DOB, prescriber, pharmacy).
Request that we look into reducing a copay on a medication for a patient.
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