Medical drug prior authorization

If a drug on Priority Health's Medical Drug List (MDL) requires prior authorization (PA), providers can submit a coverage request to our Pharmacy Department using one of the following methods:

Fax: Complete the appropriate prior authorization form and fax it to 877.974.4411

Online: Submit your request through the web form

To avoid delays, be sure to include all required clinical information and supporting documentation with your request.

Forms:

• Medicare Part B versus Medicare Part D coverage determination form
• Medicare Part B prior authorization form
• Medicare Part B oncology prior authorization form

If a drug on Priority Health's Medical Drug List (MDL) requires prior authorization (PA), providers can submit a coverage request to our Pharmacy Department using one of the following methods:

• Fax: Complete the appropriate prior authorization form and fax it to 877.974.4411
• Online: Submit your request through the web form

To avoid delays, be sure to include all required clinical information and supporting documentation with your request.

Forms:

Medicaid medical drug authorization form

If a drug on Priority Health's Medical Drug List (MDL) requires prior authorization (PA), providers can submit a coverage request to our Pharmacy Department using one of the following methods:

• Fax: Complete the appropriate prior authorization form and fax it to 877.974.4411
• Online: Submit your request through the web form

To avoid delays, be sure to include all required clinical information and supporting documentation with your request.

Forms:

Medical drug authorization form (non-oncology)

Medical oncology drug request form