Pharmacy prior authorization
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Request a pharmacy prior authorization (PA)
To request PA by phone
- Call the pharmacy authorization services line at 1-800-562-3022 ext. 15483.
To fax PA requests
- Download and complete the Pharmacy Information Authorization form (13-835A) and send to 1-833-991-0704.
To request a change in fee-for-service (FFS) reimbursement
- Download and complete the Pharmacy Information Authorization form (13-835A). Fax request to 1-833-991-0704.
- For questions, please email the pharmacy rates team.
To submit supporting documentation to an existing authorization
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If supporting documentation was requested by HCA on a drug or drug class specific form, fax the form as the first page followed by the supporting documentation; OR
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If HCA did not fax a specific form, fax a completed Pharmacy Information Authorization (HCA 13-835A) form as the first page followed by supporting documentation.
Note: For information on billing and rates, the Apple Health preferred drug list, and expedited authorization codes, please visit the Prescription Drug Program on our provider billing guide and rates page.