- Form can be faxed to: 1 (866) 759-4115
- Phone number: 1 (800) 241-8335
- Preferred Drug List
- Other PA Forms
Nebraska Medicaid Prior (Rx) Authorization Form
A Nebraska Medicaid prior authorization form is used by a prescribing physician to request Medicaid coverage for drugs that are otherwise not covered by a patient's Medicaid plan. This occurs when the doctor prescribes a medication that is not on the preferred drug list.
Updated November 13, 2024
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