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Prior Authorization

Required on some medications before your drug will be covered. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. To obtain the correct form, select the appropriate drug below and follow the instructions at the top of the form. You can search this page by using the search function within your application. (Press Ctrl+F on Windows or Command+F on Mac to bring up the search bar).

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Prior Authorization © Prime Therapeutics LLC