Community Plan Pharmacy Prior Authorization

Official Website: https://www.uhcprovider.com

Forms & Documents

Browse all Community Plan Pharmacy Prior Authorization forms

1 - 20 of 31 documents

Form Title Tags
Abstral / Antiq / Fentora / Lazanda / Subsys (Florida) Prior Authorization Form - Community PlanOpens in a new window
Actemra (FL, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community PlanOpens in a new window
Acthar Gel (Florida) Prior Authorization Form - Community PlanOpens in a new window
Actimmune (Arizona, Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
ADHD Products (FL, HI, NJ, NY) Prior Authorization Form - Community Plan
Afinitor (Arizona, Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
Afrezza (AZ, FL, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community PlanOpens in a new window
Albumin (Florida) Prior Authorization Form - Community PlanOpens in a new window
Alecensa (Arizona, Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
Alfa Interferons [Intron A, Pegasys, Pegintron, Sylatron] (FL, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community PlanOpens in a new window
Alinia (AZ, FL, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community PlanOpens in a new window
Alunbrig (Arizona, Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
Ampyra (Arizona, Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
Anthelmintics (Florida, Hawaii, Maryland, New Jersey, New York, Ohio, Pennsylvania, Rhode Island) Prior Authorization Form - Community PlanOpens in a new window
Anticonvulsants (AZ, FL, HI, NJ, NY, OH, PA, RI) Prior Authorization Form - Community PlanOpens in a new window
Antidepressants, CSFL, Under 6 Years (Florida MMA) Prior Authorization Form - Community PlanOpens in a new window
Antipsychotic, Adult High Dose (Florida MMA) Prior Authorization Form - Community PlanOpens in a new window
Antipsychotic, Age 6 to Under 18 (Florida MMA) Prior Authorization Form - Community PlanOpens in a new window
Antipsychotics (FL, NJ, NY) Prior Authorization Form - Community PlanOpens in a new window
Antipsychotic, Under Age 6 Years (Florida MMA) Prior Authorization Form - Community PlanOpens in a new window

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