Updated July 27, 2023
An Alabama Medicaid prior authorization is an appeal to the State that a specific non-preferred drug should be prescribed by a physician and covered under the State’s Medicaid coverage. It may either be filed in its paper form or submitted online. A fillable PDF version of this form can be downloaded on this page.
E-Mail – al_pa@hidinc.com
Fax – 1 (800) 748-0116
Phone – 1 (800) 748-0130
Preferred Drug List – View comparable drugs that are State-approved.
Submit Online – File this form online.