1. Select Form

There are two ways a request can be created:

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
• 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.

2. Complete Form

Each form will require some basic information (patient name, DOB, prescriber, pharmacy). 

• Manually by typing information.
• Adding a screenshot.
• Uploading excel file (for many requests at once).