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Provider Forms

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Behavioral Health

Additional program information coming soon.


Physicians can access, complete and submit Prior Authorization and Step Therapy request forms electronically from the CoverMyMeds® website:

For more information on CoverMyMeds®, click here

Pharmacy Drug:

Pharmacy Predetermination Physician Fax Forms:

Prime Specialty Pharmacy Referral:

Predeterminations (formerly called Prior Authorization) and Pre-Authorization/Precertification


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