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Pharmacy prior authorization guidelines

The decision-making process

Some medications on the formulary need prior authorization (PA) before they can be dispensed. First, you’ll request PA for a member’s medication. Then, MedImpact will review your request and make a decision based on nationally recognized prior authorization guidelines. If you have any questions, please contact MedImpact at 1-800-210-7628 (TTY: 711) or visit their website at:


Single preferred drug list criteria for PA (PDF) 

For more info

If you have questions or would like a copy of these guidelines, call Provider Relations at 1-855-300-5528 (TTY: 711). We’re here Monday through Friday, 7 AM to 7 PM ET.

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