For providers: How can I get prior authorization for a medical drug?
Who is this for?
If you're a doctor prescribing a specialty drug that requires our approval, you can log in to Provider Secured Services and request authorization.
When a patient needs a specialty drug and we need to approve it first, you can ask for authorization online in Provider Secured Services. Look for the link to Medical Benefit-Medication Prior Authorization on the home page. Here's how to make sure you have access.
What you need to request medical drug authorization
First, the request must come from a medical doctor. The doctor can practice in an office or a facility.
Then, we need one or two forms before you ask for authorization for the first time.
- If you already use Provider Secured Services, we need a copy of this form: Addendum P (PDF). Just fill it out and mail or fax it to us.
- If your office or facility has never used Provider Secured Services: You'll need to sign up. This article has the instructions and forms. Be sure to check Medical Drug PA in Section 6 when completing the application.
Who can't access medical drug authorization
If you're one of these providers, you can't request authorization. The patient's doctor must do that.
- Billing and insurance services
- Immunization pharmacies
- Specialty pharmacies
- Ambulatory infusion centers
- Home infusion therapy
If you need an approval date or authorization number for the claim form, contact the doctor prescribing the drug.