PREAUTHORIZATION FORMS
OBTAINING AN AUTHORIZATION FOR CERTAIN REQUIRED TYPES OF TREATMENTS BEFORE THEY ARE PERFORMED, WHICH CAN BE FOUND ON THIS PHARMACY POLICY SITE. AUTHORIZATION REQUESTS CAN TAKE UP TO 15 CALENDAR DAYS TO COMPLETE. PLEASE ALLOW AT LEAST 15 DAYS FROM THE TIME OF YOUR REQUEST TO RECEIVE NOTIFICATION OF OUR DECISION.
- Self-Administered Oncology Preauthorization Form 10/2/2023 6:35:57 PM +00:00
- Xolair Preauthorization Form 10/23/2019 12:00:00 AM -05:00
- Growth Hormone Preauthorization Form 10/2/2023 6:35:34 PM +00:00
- ProliaTM Preauthorization Form 10/2/2023 6:35:38 PM +00:00
- Brand Name Oral Acne Antibiotics Preauthorization Form 10/2/2023 6:35:42 PM +00:00
- Biologics (Rheumatic, Psoriasis and Gastrointestinal Disorders) Preauthorization Form 10/2/2023 6:35:47 PM +00:00
- General Medication Preauthorization Form 10/2/2023 6:35:50 PM +00:00
- Androgen Preauthorization Form 10/2/2023 6:35:54 PM +00:00
- Standard Prescription Drug Guide 4/16/2025 11:06:52 PM +00:00
- Standard Prescription Drug Guide Updates 4/16/2025 11:06:52 PM +00:00
- Contraception Drugs and Methods Pharmacy List 8/17/2020 9:21:38 PM +00:00
- Outpatient Drug Exclusions List 6/30/2021 9:56:51 PM +00:00
- Preventive Prescription Drug List 10/2/2023 6:35:31 PM +00:00
- Standard Pharmacy-Related Prior Authorizations 8/17/2020 9:21:30 PM +00:00
- Specialty Pharmacy Information 6/30/2021 9:57:26 PM +00:00
- Specialty Pharmacy Drug Management List 4/16/2025 11:06:52 PM +00:00
- Specialty Medication Enrollment Form 6/30/2021 9:57:12 PM +00:00
- Home Delivery Registration & Prescription Order Form 6/30/2021 9:56:09 PM +00:00
