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 | Categories | Update Date | Download |
|---|---|---|---|
|
FDA Medwatch Form 1 file(s) 552 downloads |
BCBSAL, BCBSFL, HiLab, HWMG, RxBenefits, sscripts | May 14, 2019 | Download |
|
Opioid Informed Consent 1 file(s) 50 downloads |
HWMG | March 11, 2019 | Download |
|
Prior Authorization Request Form 1 file(s) 2037 downloads |
HWMG | November 27, 2018 | Download |