- Allergen Extract Medications Prior Authorization Drug Approval Form
- Antifungal Medication for Onychomycosis Prior Authorization Drug Approval Form
- Antiobesity Medications Prior Authorization Request Form
- Asthma/Allergy Immunomodulator Prior Authorization Drug Approval Form
- Bowel Disorder Medications Prior Authorization Drug Approval Form
- Benign Prostatic Hyperplasia (BPH) Medications Prior Authorization Request Form
- Brand Name Multiple Source Prescription Medications Prior Authorization Request Form
- Calcitonin Gene-Related Peptide (CGRP) Inhibitor Request Form
- Carisoprodol and Combination Medications Request Form
- CNS Stimulant & ADHD/ADD Medication Prior Authorization Drug Approval Form
- Cymbalta® Prior Authorization Drug Approval Form
- Direct Renin Inhibitors & Combination Medications Prior Authorization Request Form
- Fibromyalgia Medications Prior Authorization Drug Approval Form
- Hematopoietic Agent Prior Authorization Drug Approval Form
- Hepatitis C Medications Prior Authorization Drug Approval Form
- Huntington's Disease Medications (For Xenazine® Request) Prior Authorization Request Form
- Inhaled Insulin Medications Prior Authorization Drug Approval Form
- Legend Topical NSAIDS Medications Prior Authorization Request Form
- Long Acting Opioid Analgesic Prior Authorization Drug Approval Form
- Morphine Milligram Equivalent (MME) Prior Authorization Drug Approval Form
- Non-Preferred Prior Authorization Fax Form
- Lyrica® Prior Authorization Drug Approval Form
- Oral Isotretinoin Medications Prior Authorization Drug Approval Form
- Oral NSAIDS Legend Medications Prior Authorization Request Form
- Proton Pump Inhibitors Prior Authorization Request Form
- Pulmonary Arterial Hypertension – Phosphodiesterase Type-5 (PDE-5) Inhibitor Only Prior Authorization Drug Approval Form
- Receptor Selective NSAID Medication Prior Authorization Drug Approval Form
- Restless Leg Syndrome Medication Prior Authorization Drug Approval Form
- Rho Kinase Inhibitor Form
- Short-Acting Fentanyl Analgesic Medication Prior Authorization Drug Approval Form
- Suboxone®/Buprenorphine Prior Authorization Drug Approval Form
- Symlin® (pramlinitide acetate) Prior Authorization Drug Approval Form
- Synagis® Prior Authorization Drug Approval Form
- Systemic Immunomodulators Medication Prior Authorization Drug Approval Form
- Topical Acne Medications Prior Authorization Request Form
- Topical Immunomodulators Medications Prior Authorization Request Form
- Transmucosal Analgesic Medications Prior Authorization Request Form
- Xenical® Prior Authorization Request Form