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Pharmacy Resources & Forms

Tools & Forms

Provider specific information to help manage plan member's health.


Provider Forms

Drug Authorization Forms

  • Pharmaceutical Exception Request Form
    Use this form for requesting an exception when a drug authorization form is not available.
  • Medication Review Request Fax Cover
    Use this fax cover sheet if your authorization request was denied and you are requesting an appeal, or if you are requesting review for coverage of an excluded pharmacy product. Please note: This form is a cover sheet only. You are required to submit pertinent medical information that supports the pharmacy related request along with this fax cover form.


Pharmacy Programs

How the Health Insurance Marketplace May Impact You

You already help your patients improve their health. Now you can help connect them to the Health Insurance Marketplace.

Find out more about the Marketplace