Use this form when requesting prior authorization for medical drugs in Oregon.

In this section you will find the tools and resources you need to help manage your practice’s prior authorization and notification requirements, with program specific information available for Cardiology, Oncology, Radiology, Clinical Pharmacy and...

Please send this request to the issuer from whom you are seeking authorization. Do not send this form to the Texas Department of Insurance, the Texas Health and Human Services Commission, or the patient’s or subscriber’s employer.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs.

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.

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

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.

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

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

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.

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

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

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.

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

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

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.