Prior Authorization

MedicareBlue Rx coverage requires prior authorization for certain covered drugs that have been approved by the Food and Drug Administration (FDA) for specific medical conditions.

Forms you will need for Prior Authorization

Request a coverage decision (sometimes called a prior authorization or exception) for a drug if your health care provider or pharmacist tells you a prescription drug is not covered in your treatment plan: get more information on a coverage determination here.

Related Prior Authorization and Coverage Determination forms are located on the documents page.

Prior authorization program guidelines:

  • The prescribing physician can fax the applicable form to MedicareBlue Rx for any exception request.
  • Contact Customer Service for MedicareBlue Rx:
    • Toll Free 1-888-832-0075 | Employer Group Members call 1-877-838-3827
    • TTY hearing impaired users call 711
  • Once the drug is authorized, it can be filled at any participating pharmacy (except for the few drugs which may require a specialty pharmacy; check with your pharmacist or physician).

Search the drug list (formulary) to find out if your drug requires prior authorization.