Alabama prior authorization 2026

1. Click ‘Get Form’ to open the Alabama Prior Authorization Request Form in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's name, Medicaid number, date of birth, and phone number. If applicable, indicate if the patient is a nursing home resident.
3. Next, complete the Prescriber Information section. Provide the prescriber's name, NPI number, phone number, address (optional), license number, and fax number.
4. In the Clinical Information section, specify the drug requested along with its J Code (if applicable), strength, quantity, days supply, and diagnosis or ICD-10 code. Indicate whether this is an initial request or a renewal.
5. Fill out Drug Specific Information by selecting relevant categories and providing details on previous drug usage and treatment duration.
6. Complete the Dispensing Pharmacy Information section with pharmacy details including name, phone number, NPI number, and fax number.

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