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Georgia Medicaid Prior (Rx) Authorization Form

Georgia Medicaid Prior (Rx) Authorization Form

Updated July 27, 2023

Georgia Medicaid prior authorization form is used by medical professionals in Georgia to request Medicaid coverage of a non-preferred drug on behalf of a patient. In addition to filling out this form, any supporting medical documentation and notes that help to justify this request must be included. When submitting this form, please consult your directory for the correct fax number to send your request to.

Preferred Drug List – List of pre-approved drugs by the State