Drug authorizations

Drug authorization forms

For authorization forms and more drug-specific information, click the drug name below. For a list of physician-administered drugs requiring prior authorization, download the injectable drug list.

Use the right form for the member’s Priority Health plan:

Traditional: Most employer group plan members
Optimized: MyPriority individual plans and some employer group plans (member ID card will show Optimized RX: Yes)
Medicaid: Medicaid and Healthy Michigan plan members
Medicare: Medicare Advantage plan members and employer-sponsored Medicare plans such as MPSERS

Priority Health Medicaid and Medicare Part D no longer utilize drug-specific prior authorization forms for drugs covered under the pharmacy benefit. Visit the Approved Drug List (ADL) to search by drug name and view the criteria and PA forms.

Medicaid ADL  Medicare ADL

Find drug-specific coverage, authorization and billing information

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