Questions? Call us at
877.436.7748
(TTY 711) 8 a.m. to 8 p.m.
Log in
Open
MENU
Home
Drug authorization forms
Daklinza®
Back
Daklinza
®
(daclatasvir)
Authorization forms
Traditional (11/2017)
Optimized (11/2017)
Medicare (09/2018)
Drug-specific auth forms
Approved Drug List
Our plans
About us
Magazine
Careers
Contact us
Member
Employer
Provider
Agent
Search site
Search
Search
Looking for a provider or approved drug?
Approved drug list
Find a doctor
Close
Top
