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Medical Exception/Prior Authorization/Precertification
Medical Exception/Prior. Authorization/Precertification*. Request for Prescription. Medications. Fax this form to: 1-877-269-9916. OR. Submit your request
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Molina Healthcare of Ohio Prior Authorization (PA) List
The PA process is initiated by the prescriber completing a PA form requesting the medication and faxing it to. Molina Healthcare at (800) 961-5160. A PA form
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Request for Prior Authorization LIDOCAINE PATCH FAX
Request for Prior Authorization. LIDOCAINE PATCH. FAX Completed Form To. 1 (800) 574-2515 Prior authorization is required for topical lidocaine patches.
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