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Indiana Community Plan Pharmacy Prior Authorization Forms

To simplify your experience with prior authorization and save time, please submit your prior authorization request through the following online portals:

Electronic Prior Authorization (ePA)

Submit an ePA using CoverMyMeds

Select

Electronic prior authorization (ePA)

Submit an ePA using SureScripts

Select

Otherwise, you can submit requests by completing and faxing the Prior Authorization Request form. If you have questions, please contact your provider advocate or call the Pharmacy Prior Authorization service at 800-310-6826.