Access key forms for authorizations, claims, pharmacy and more.
This request will be treated as per the standard organization determination time frames.
Refund Check Information Sheet* (RCIS)
Below are the most commonly prescribed medications that were on the 2018 formulary and their preferred 2019 alternatives.
Drug Prior Authorization Requests Supplied by the Physician/Facility
Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.
Fill out and submit this form to request an appeal for Medicare medications.