Forms & Documents. Prior Authorization Request Form. To submit a prior authorization request, please complete the Prescription Drug Prior Authorization Form ...

1 июл. 2018 г. · To submit a prior authorization request, please complete the Prescription Drug Prior. Authorization Form and send it (along with additional ...

Forms & Documents. Access Formulary Look-Up, Prior Authorization Forms, Pharmacy Network List, and more · FAQs · Prescriber Help Desk. 1-888-832-2779. For ...

Prescription Drug Prior Authorization Form. Instructions: Please fill out all applicable sections on both pages completely and legibly.

CapitalRx has partnered with CoverMyMeds to offer electronic prior authorization (ePA) services. Select the appropriate CapitalRx form to get started.

I authorize the release of any medical information pertaining to this claim ... Blank forms are available by visiting https://www.cap-rx.com/members#member-forms.

Call customer service at 1-877-227-7995 to determine if your medication(s) are subject to prior authorization, step therapy, and/or quantity limit requirements.

Prior authorization request forms can also be sent via mail to the below address: Capital Rx, Inc. Attn: Prior Authorization Department. 228 Park Avenue South, ...

Prior authorization requires you and your physician to obtain approval from Capital Rx prior to medication being dispensed. • Step therapy is when your ...

What is a Prior Authorization (PA): Approval may be required before your pharmacy benefit plan will cover certain drugs. This process ensures you receive a ...