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Highmark Prior (Rx) Authorization Form

A Highmark prior authorization form is a document used to determine whether a patient's prescription cost will be covered by their Highmark health insurance plan. A physician must fill in the form with the patient's information and all medical details related to the requested prescription before it is submitted.
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  • Fax: 1 (866) 240-8123
  • Mail: Medical Management & Policy, 120 Fifth Avenue, MC P4207, Pittsburgh, PA 15222