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South Dakota Medicaid Prior Authorization Form

South Dakota Medicaid Prior Authorization Form

Updated July 27, 2023

A South Dakota Medicaid prior authorization form is a document that is used by medical practitioners in order to request Medicaid coverage for drugs not included on the State-approved Preferred Drug List (PDL). Using this form, the physician will provide a medical justification for making this request. Once completed, this form should be faxed to the South Dakota Department of Social Services Prior Authorization fax number which can be found immediately below this paragraph.

Fax – 1 (866) 254-0761

Phone – 1 (866) 705-5391