Updated July 27, 2023
An Idaho Medicaid prior authorization form is used by an Idaho-based physician who wishes to request Medicaid coverage for a non-preferred drug prescription. Within this form, you will be required to provide your patient’s medical history in relation to the relevant diagnosis, as well as a clinical justification for this request. Once complete, this form must be faxed to the appropriate Medicaid directory. For more information, call the Idaho Medicaid Pharmacy Call Center number which is provided below.
Phone – 1 (866) 827-9967