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SAV-RX Prior (Rx) Authorization Form

SAV-RX Prior (Rx) Authorization Form

Updated July 27, 2023

An SAV-RX prior authorization form is used by prescribing physician’s to request a specific drug treatment plan for their patient. Some medications are not covered by certain insurance plans, therefore, the doctor must disclose their medical reasoning for prescribing the patient this particular drug when other cheaper, generic drugs might be used instead. The physician must complete the prior authorization form and send it in to SAV-RX for review. Not all prior authorization requests will be approved, at which point the patient must choose between paying for the drug out of pocket or treating themselves with a cheaper medication.

  • Form can be faxed to: 1 (888) 810-1394