Skip to Main Content

Resources / Materials

WEBSITE RESOURCES AND MATERIALS

  • Prior Authorization Form (PDF) You cannot use this form for Medicare non-covered drugs. Non-covered drugs include but are not limited to fertility drugs, drugs given for weight loss, weight gain or hair growth, over-the-counter drugs, or prescription vitamins (except prenatal vitamins and fluoride preparations).

Last Updated: 04/19/2018
H6870_18_WebCAHPS_Approved_04192018