Prior Authorization (PA) Forms

General PA Form

Antipsychotic PA Forms

High Cost Drugs

Medwatch Form *For pr​escrib​ers to justify and attest for “Brand Medically Necessary"

Specialty PA Forms

   ​Synagis PA Forms *Updated for 2021-2022 RSV Season

   Nutritional Supplement PA Forms

   Substance Use Disorder PA Forms

   Clotting Factor Replacement Therapy PA Forms

   Pharmacy Compounding