- Prior Authorization Form
- Fax to: 1 (877) 243-6930
- Phone: 1 (800) 285-9426
- Part D Prior Authorization Form (Medicare)
- Part D Fax to: 1 (800) 693-6703
Prime Therapeutics Prior (Rx) Authorization Form
A Prime Therapeutics prior authorization form, also known as a Formulary Exception Form, is used to request coverage for a patient’s prescription that isn't listed on their health insurance provider’s formulary. The document describes the diagnosis and an explanation for why the prescription is recommended.
Updated November 15, 2024
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