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SilverScript Prior (Rx) Authorization Form

SilverScript Prior (Rx) Authorization Form

Updated July 27, 2023

A SilverScript prior authorization form is required in order for certain drug prescriptions to be covered by an insurance plan. Insurance policies have their limitations and, in some cases, a physician must complete and submit the SilverScript prior authorization form in order to get approval for the drug they intend to prescribe to their patient. The prescribing doctor has to justify their reasoning and explain why that specific drug (as opposed to generic or less expensive options) is completely necessary for the patient’s condition. If any necessary information is excluded on the prior authorization form, SilverScript may not approve coverage of the drug.

  • Form can be faxed to: 1 (855) 633-7673