Please enter your group contract number to verify if your drug plan includes Prior Authorization. If you're not sure what your contract number is, please contact your Benefits Administrator.
Prior Authorization Drug List and Forms
Please enter your group contract number to verify if your drug plan includes Prior Authorization. If you're not sure what your contract number is, please contact your Benefits Administrator.
Please choose the form you need from the list below. If the form doesn’t load, try using a different web browser. You can also save the form to your computer:
Drug Category | Drugs | Prior Authorization Form |
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