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)  404 downloads

BCBSAL

November 16, 2016

Download

FDA Medwatch Form
 1 file(s)  700 downloads

BCBSAL, BCBSFL, HiLab, HWMG, RxBenefits, sscripts

May 14, 2019

Download

FDA MedWatch Form 3500
 1 file(s)  139 downloads

BCBSAL

May 15, 2017

Download

General PA Form
 1 file(s)  18569 downloads

BCBSAL

November 16, 2016

Download

Opioid PA Request Form
 1 file(s)  1253 downloads

BCBSAL

March 29, 2018

Download

Part D Form
 1 file(s)  575 downloads

BCBSAL

November 16, 2016

Download

PCSI 10
 1 file(s)  510 downloads

BCBSAL

November 16, 2016

Download

Pegasys
 1 file(s)  105 downloads

BCBSAL

November 16, 2016

Download

Specialty Pharmacy Form
 1 file(s)  2544 downloads

BCBSAL

November 16, 2016

Download

Suboxone Subutex Prior Authorization Request Form
 1 file(s)  580 downloads

BCBSAL

November 16, 2016

Download

Substance Abuse Authorization Form
 1 file(s)  94 downloads

BCBSAL

November 16, 2016

Download

Synagis Authorization Request Form
 1 file(s)  78 downloads

BCBSAL

November 16, 2016

Download