Drug authorization forms

Check the Injectable Drug List first to see what authorization form is required. Drugs that require the general prior authorization form or the general oncology prior authorization form may no longer have a drug-specific page.

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

Looking for a drug covered under the pharmacy benefit?

Visit the Approved Drug List (ADL) to search by drug name and view the prior authorization criteria.

Employer and Employee ADL  Medicaid ADL  Medicare ADL  MyPriority ADL

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