Prior Approval Process

Friday, June 12, 2026

<- Bookmarkable Link Bookmark star and question mark Click here for help and information about bookmarks

»	User Information



Login/Manage Account Login/Manage Account	Login

Prior Approval Process

This section contains documentation related the Prior Approval Process.

PDF Reader Required

NOTE: If you don't have a PDF reader already installed, Adobe Acrobat Reader is required to view these documents. Click here to obtain the latest version of the free Adobe Reader.

File Download Issues

Some users may have difficulty downloading files. Often this is caused by pop-up windows being blocked or by security settings in the browser. Click here for help with download issues.

Prior Approval Process (6 rows returned) List

»	Prior Approval Process (6 rows returned)

Pharmacy Prior Authorization Request Process Guide

PDF

198.4

12/19/2023

Non-Preferred Statin Request Form

PDF

157.8

09/05/2018

Proton Pump Inhibitors PA Request Form

PDF

106.9

09/05/2018

Tobacco Cessation PA Request Form

PDF

124.5

09/05/2018

Multi-Ingredient Compound Drug PA Request Form

PDF

115.8

10/31/2017

Nursing Facility Prior Authorization Issue Correction Steps

PDF

422.8

02/16/2015

	English \| Español \| Accessibility \| Privacy \| AMA & ADA Copyright
© Copyright 2026 Gainwell Technologies

User Information

Prior Approval Process (6 rows returned)