BCBS of Alabama

To submit a prior authorization online, please click the button below to use the web form.

PDF forms are available below to submit a prior authorization through fax.

Title
Compounding Coverage Authorization Request Form
 1 file(s)  435 downloads

BCBSAL

November 16, 2016

Download

FDA Medwatch Form
 1 file(s)  801 downloads

BCBSAL, BCBSFL, HiLab, HWMG, RxBenefits, sscripts

May 14, 2019

Download

FDA MedWatch Form 3500
 1 file(s)  147 downloads

BCBSAL

May 15, 2017

Download

General PA Form
 1 file(s)  19122 downloads

BCBSAL

November 16, 2016

Download

Opioid PA Request Form
 1 file(s)  1304 downloads

BCBSAL

March 29, 2018

Download

Part D Form
 1 file(s)  598 downloads

BCBSAL

November 16, 2016

Download

PCSI 10
 1 file(s)  523 downloads

BCBSAL

November 16, 2016

Download

Pegasys
 1 file(s)  111 downloads

BCBSAL

November 16, 2016

Download

Specialty Pharmacy Form
 1 file(s)  2640 downloads

BCBSAL

November 16, 2016

Download

Suboxone Subutex Prior Authorization Request Form
 1 file(s)  591 downloads

BCBSAL

November 16, 2016

Download

Substance Abuse Authorization Form
 1 file(s)  98 downloads

BCBSAL

November 16, 2016

Download

Synagis Authorization Request Form
 1 file(s)  86 downloads

BCBSAL

November 16, 2016

Download