Prior authorization drugs
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.
- Print the prior authorization form below.
- Fill in the sections marked “Patient Information.”
- Ask your doctor to complete the “Physician Information” sections.
- When the form is completed, return it to us using the contact information on the form.
-
Use this form to request approval for a drug claim. Your physician will need to fill out some sections.
-
Use this form to request approval for medical cannabis coverage. You’ll need the doctor to fill in some sections.
Not the forms you're looking for? Go back to the find a form page.