Prior Authorization

Select his option if you would like to create a request for:

• Prior Authorization
• Appeals

Financial Assistance

Request that we look into reducing a copay on a medication for a patient.

1. Select Form

There are two ways a request can be created:

• 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. 
• General Form - Can be used for any drug.