Pharmacy Advantage

Pharmacy Advantage

Customer Service Hours
Monday - Friday: 7am - 7pm (EST)
Saturday: 8am - 4pm (EST)
Closed: Sunday & National Holidays
Phone: (800) 456-2112
After hours on–call services available

URAC Accredited

Prior Authorization Forms

Forms Are Organized By Condition

These forms are for use by physicians and pharmacists.

Click one of the links below to open up a PDF version of the chosen Medication Request Form. You will be able to save or print the PDF after completion.