Pharmacy prior authorization
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Request a pharmacy prior authorization
For phone requests or emergencies
- Call the pharmacy authorization services line at 1-800-562-3022 ext. 15483.
For fax requests
- Download and complete the Pharmacy Information Authorization form (13-835A) and send to 1-866-668-1214.
For reimbursement requests at less than cost, not related to brand name dispense as written (DAW)
- For phone requests
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Call the pharmacy rates department at 1-800-562-3022 ext. 16135.
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- For fax requests
- Download and complete the Pharmacy Information Authorization form (13-835A)Â and send to 1-866-668-1214.
Note: For information on billing and rates, the Apple Health preferred drug list, and expedited authorization codes, please visit the Prescription Drug Program on our provider billing guide and rates page.