Option Care Health - Special Pharmacy Form

UHC – MEDICATION SOURCING EXPANSION PRESCRIBER ORDER FORM: Submit completed form and clinical documentation.

Preferred Non-Solid Dosage Forms - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona

UnitedHealthcare Community Plan Pharmacy prior authorization guidelines for AZ - Preferred Non-Solid Dosage Forms

Preferred Non-Solid Dosage Forms - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of California

UnitedHealthcare Community Plan Pharmacy prior authorization guidelines for CA - Preferred Non-Solid Dosage Forms

Uniform Prior Authorization Prescription Request, form (440-4992)

OAR 836-053-1205: Exhibit 1, Uniform Prior Authorization Prescription Request, form (440-4992)

Skilled Nursing Facilities: UnitedHealthcare Clinical and Therapy Request Form

UnitedHealthcare Clinical Services and Therapy Request Form

Personal Care Work Services (PCW) Prior Authorization Fax Form - UnitedHealthcare Community Plan of Wisconsin

Prior Authorization Fax Form

Cometriq (Washington) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Washington UnitedHealthcare Community Plan

Provigil / Nuvigil (Virginia) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following states: Virginia Commonwealth Coordinated Care Plus (CCC Plus)

Fentanyl Immediate Release (Washington) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Washington UnitedHealthcare Community Plan

Ohio Community Plan Prenatal Risk Assessment form incentives | UHCprovider.com

Prenatal Risk Assessment forms (PRAF) are important for the care and referral of patients. They also help ensure that moms receive the best support for a healthy pregnancy. When you fill out the form, we’re notified of the member’s pregnancy, so ...

Colorado Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Colorado Community Plan care providers.

Hawaii Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Hawaii Community Plan care providers.

Arizona Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Arizona Community Plan care providers.

New Jersey Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of New Jersey Community Plan care providers.

Maryland Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Maryland Community Plan care providers.

Pennsylvania Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Pennsylvania Community Plan care providers.