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MassHealth Prior (Rx) Authorization Form

MassHealth Prior (Rx) Authorization Form

Updated July 27, 2023

A MassHealth Prior Authorization Form is used by a medical office when they wish to request coverage from MassHealth for a prescription not listed on the formulary on behalf of a patient. This action is usually taken when other medications have been unsuccessful in treating their patient for a particular diagnosis. By filling and submitting this form, the medical professional may be able to secure coverage of a particular prescription for their patient.

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