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To submit a prior authorization online, please click the button below to use the web form. Medicare part d prescription drug authorization request form this form is for authorization of prescription drug benefits only and must be. If you have any questions or comments about the forms, please contact us. Find medical policies and clinical guidelines.
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Thank you for browsing our provider forms. To see if precertification is needed for a patient, check eligibility and benefits through provideraccess or your practice management.