Ozempic prior authorization form sunlife 2026

1. Click ‘Get Form’ to open the ozempic prior authorization form in the editor.
2. Begin by filling out the plan member information section. Enter your contract number, member ID, last name, first name, and address. Don’t forget to select your gender and preferred language of correspondence.
3. Provide your date of birth and daytime phone number. If applicable, fill in the claimant's information including their last name, first name, date of birth, and relationship to you.
4. In the authorization and signature section, certify that the information is accurate by signing and dating the form.
5. Next, have your prescribing physician complete their section. They will need to provide their details along with the drug name (Ozempic) and relevant medical criteria for approval.
6. Finally, review all sections for completeness before submitting. Ensure you attach any necessary receipts if you've already purchased Ozempic.

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