New York 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
Electronic prior authorization (ePA)
Submit an ePA using SureScripts
Otherwise, you can submit requests by completing and faxing the applicable form below. You can search for a drug specific form by entering the requested drug in the search box below. If your search does not yield a result, please use this Prior Authorization Request form.
Contraceptive exception (New York Essential Plan) Prior Authorization Form - Community Plan
Last Published 12.30.2023
Use this paper fax form to submit requests for the following state plans: New York Essential Plan