Pharmacy Prior Authorization

Pharmacy prior authorizations are required for pharmaceuticals that are not in the formulary, not normally covered, or which have been indicated as requiring prior authorization.

For more information on the pharmacy prior authorization process, call the Pharmacy Services department at 1-866-610-2774.

How to submit a request for pharmacy prior authorization

Online

Save time by submitting all your pharmacy prior authorization requests online. Get started at our online prior authorization request form or learn more in our tutorial.

By phone

Call the Pharmacy Services department at 1-866-610-2774. If it’s outside of normal business hours, you can also call Member Services at 1-888-991-7200.

By fax

You can fax your prior authorization request form (PDF) to 1-888-981-5202.

Prior authorization criteria

Many medicines have specific requirements and conditions that must be met to receive prior authorization. Save time by viewing a list of medications and their prior authorization criteria (PDF) before submitting your request.

HCPCS medication codes requiring prior authorization

View list of HCPCS codes that require prior authorization (PDF)

View the HCPCS Authorization Form (PDF)

Specialty and injectable request forms

Specialty drugs include unusually high-cost oral, inhaled, injectable, and infused pharmaceuticals prescribed for a relatively narrow spectrum of diseases and conditions.

To initiate a request for specialty or injectable drugs administered in a physician’s office, or for injectable medications dispensed through network specialty or retail pharmacies for patient self-administration, use one of the drug- or class-specific prior authorization request forms below.