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Express Scripts Prior (Rx) Authorization Form

Express Scripts Prior (Rx) Authorization Form

Updated July 27, 2023

An Express Scripts prior authorization form is meant to be used by medical offices when requesting coverage for a patient’s prescription. The medical staff will need to fill out the form with the patient’s personal and medical details, as well the prescriber’s information, before delivering it to Express Scrips for review. For your convenience, we have provided the authorization form within this webpage which you can download and complete on your computer.

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