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Prior authorization drugs

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How to request coverage for a brand name prescription drug

There are some brand name prescription drugs that need to be individually approved for before you can be reimbursed.

Learn more about the reimbursement process  .

If your workplace plan covers the drug, you’ll need to complete the following steps to be considered for coverage.

  1. Print the prior authorization form below.
  2. Fill in the sections marked “Patient Information.”
  3. Ask your doctor to complete the “Physician Information” sections.
  4. When the form is completed, return it to us using the contact information on the form.

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