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Rhode Island Medicaid Prior Authorization Form

Rhode Island Medicaid prior authorization form is a document used to request Medicaid coverage for a medication that is not on the preferred drug list. A healthcare provider must submit this form when prescribing a non-preferred drug to a Medicaid patient. They must also provide the medical justification for prescribing the medication.
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Fax – 1 (401) 784-3889

Phone – 1 (401) 462-5300

Preferred Drug List – Acceptable drugs by the State