Download a Drug Authorization form

Instructions for the mobile app

1. Select Coverage and then Coverage.

2. In the Check Coverage section, select View All.

3. Select Drug (Prescription) and then Drug.

4. In the Member drop-down menu, select a plan member.

5. In the Drug Details field, type the medication you are looking for.

6. Select Continue.

7. Select the medication you are looking for and select Access Form.

8. On the ProviderConnect page that appears, enter the name of the drug you are looking for and select Search.

9. Select Download.

Instructions for the web app

1. On the Navigation Bar, select Coverage and then Check Coverage.

2. In the Explore by Category section, select Drug (Prescription).

3. In the Plan member drop-down menu, select Plan Member.

4. In the Drug name field, enter the drug you are looking for.

5. Select Search.

6. Find the medication you are looking for and select View Details.

7. On the Exception Drug Requires Authorization screen, select Access Form.

8. On the ProviderConnect page that appears, enter the name of the drug you are looking for and select Search.

9. Select Download.