Prior Authorization Requests

A Prior Authorization (called a PA) is a means your health insurer uses to control pharmaceutical costs by attempting to limit or control your access to certain medications.  Sometimes, when your doctor sends in a prescription for you, you'll be told by your pharmacist that a PA is required.  You should know that a prescription authored by your doctor can be filled, even if it may not be covered by your insurance. If you are told by the pharmacist that a PA is needed, first ask if there is an alternative medicine that is covered. If not, you should use this form to request a PA; we can not guarantee we will get pharmacy requests for PA's. 

The form below should be used to request work on your PA. Complete and submit the form below. We cannot guarantee a PA will be approve. If you have any questions, or wish to appeal a denied PA, please contact your health insurer.

Insurers employ Pharmacy Benefit Managers (PBM) to control drug costs. These will have a unique member card, in most cases different from your medical insurer. We need the information from that card in order to work your PA.

Complete the form below. Specificity will help speed the process.

We will work this PA as soon as we are able and will contact you (usually by text) if more information is needed. It can take up to two weeks to complete. We will contact you when we have a decision from your insurer.

Thank you