eForms Logo

Alaska Medicaid Prior (Rx) Authorization Form

An Alaska Medicaid prior authorization form is used by a medical professional in order to request coverage through state Medicaid for a non-preferred drug prescription. Submitting this form, along with a medical explanation, is necessary for a physician to be able to treat a Medicaid patient with a medication that is not on the state's preferred drug list.
5.0 Stars | 1 Ratings
Downloads: 25

Fax – 1 (888) 603-7696

Phone – 1 (800) 331-4475

Preferred Drug List – Acceptable drugs by the State