Please provide the following details for each trial: manufacturer name, date(s) taken and for how long, and what the documented.

You can submit an online prior authorization request for any customer who has Cigna prescription coverage. Moving forward, please visit CoverMyMeds at www.

Required clinical information - Please provide all relevant clinical information to support a prior authorization or step therapy exception request review.

If your request is urgent, it is important that you call Pharmacy Services to expedite the request. View our formulary on line at http://www.cigna.com. V 041510.

Find instructions on how health care providers can request precertifications and prior authorizations for patients using PromptPA.

UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM. CONTAINS CONFIDENTIAL PATIENT INFORMATION. Complete this form in its entirety and send to: Phone: (800) 882 ...

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

Оценка 4,8 (19) A Cigna prior authorization form is required for Cigna to cover the cost of certain prescriptions for clients they insure.

Providers should consult the health plan's coverage policies, member benefits, and medical necessity guidelines to complete this form. Providers may attach any ...

Intended Use: Use this form to request authorization by fax or mail when an issuer requires prior authorization of a prescription drug, a prescription device, ...