Preferred Drug List – List of pre-approved drugs by the State
Michigan Medicaid Prior (Rx) Authorization Form
A Michigan Medicaid prior authorization form is a document submitted by a physician to request Medicaid coverage for a non-preferred drug prescription. On the form, the doctor must provide their clinical justification for prescribing a medication that is not on the preferred drug list. Supporting documentation for the diagnosis should also be included.
Updated November 13, 2024
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