If you can't submit a request via telephone, please use our general request form or one of the state specific forms below and fax it to the number on the form.
For physicians requesting a Prior Authorization for patients with insurance through Blue Cross Blue Shield of Louisiana, please call In an effort to promote transparency of its prior authorization programs, Express Scripts publishes the following approval and denial statistics. What can we show you? Tell us your role for customized content.
Provider Resource Center
Who we help. About Us. Electronic Prior Authorization Spend less time on PAs, more time on patients Did you know that over half of the prior authorizations we receive each month are electronic? Your plan includes online health tools, award-winning customer service, health and wellness programs, travel coverage, and many more benefits and services.
Manage the nuts and bolts of your plan from right here, or log in to your personalized member portal. Current Members: TTY: We occasionally require additional information when completing Medco Prior Authorization Form Provigil clinical review.
If additional information is required, we will fax a letter to your office that details what additional information is needed.
If the requested information is not received back in a timely manner the request will be denied due to lack of sufficient information for review.
Pharmacy Prior Authorization Forms
The Health Plan will notify you of its prior authorization decision via fax on the date the actual decision is made. If your office is unable to receive faxes, you will be notified via U. If you are unable to locate a specific drug on our formulary, you can also select Non-Formulary Medications, then complete and submit that prior authorization form.
Prescribing physicians can fill out the following form to request a prescription drug exception for UPMC for Life members. There are two ways you can submit this form to us:.
Pharmacy Prior Authorization | Providers | UPMC Health Plan
Search: Search. For Employers Healthy employees are happier, more productive, and have fewer absences. Pharmacy Prior Authorization. To submit a request via fax, please select the appropriate Provibil below.
Prior Authorization criteria is available upon request. If you can't submit a request via telephone, please use our general request form or one of the state. You will need authorization from Express Scripts Medicare® (PDP) before filling prescriptions for the drugs shown in the following chart. Express Scripts.