Masshealth prior authorization 2026

1. Click ‘Get Form’ to open the MassHealth Prior Authorization Request in the editor.
2. Begin by filling out the member information section. Enter the last name, first name, middle initial, MassHealth member ID, date of birth, and gender.
3. In the medication information section, specify the medication requested along with its dose, frequency, and duration. Clearly state the indication for this medication.
4. Proceed to Section I. Indicate your billing preference (Pharmacy, Prescriber in-office, or Hospital outpatient) and provide the Drug NDC if known.
5. Answer whether the member has tried other medications for this condition. If yes, provide details including drug names and any adverse reactions experienced.
6. In Section II, explain the medical necessity of the requested drug and list all current medications along with any relevant diagnostic studies performed.
7. Complete Section III if requesting a non-preferred drug product by providing justification for its necessity over preferred options.
8. Finally, fill out prescriber information and ensure to sign and date the attestation at the end of the form.

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