eForms Logo

West Virginia Medicaid Prior (Rx) Authorization Form

West Virginia Medicaid prior authorization form is completed and submitted by a physician to request Medicaid coverage for a prescribed medication that is not on the state's preferred drug list. When submitting the form, the physician must explain why it is medically necessary for their patient to be treated with a non-preferred medication.
1.0 Stars | 1 Ratings
Downloads: 104