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SilverScript Prior (Rx) Authorization Form

A SilverScript prior authorization form must be completed and submitted by a medical provider in some cases to obtain SilverScript approval for the drug they intend to prescribe to a patient. The doctor must justify their reasoning that the specific drug is necessary. Incomplete forms may not be approved by SilverScript.
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  • Form can be faxed to: 1 (855) 633-7673