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Alabama Medicaid Prior (Rx) Authorization Form - eForms 2025

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The document is an Alabama Medicaid Pharmacy Prior Authorization Request Form, which is used by healthcare providers to request approval for specific medications for patients. It includes sections for patient and prescriber information, clinical details about the drug requested, medical justification, and additional requirements based on the type of medication. The form emphasizes compliance with Alabama Medicaid guidelines and requires supporting documentation.

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Versions	Form popularity	Fillable & printable
2023	4.7 Satisfied (52 Votes)
2019	4.8 Satisfied (92 Votes)
2016	4.2 Satisfied (47 Votes)
2015	4.4 Satisfied (53 Votes)
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Does Alabama Medicaid require prior authorization?

Prior Authorization (approval in advance) is required for many procedures, services or supplies, including transportation. Click here for information on obtaining an Emergency PA for medications. Below are the forms used for Prior Authorization. Prior Review and Authorization Request Note: a completed form is required.

How do I contact Alabama Medicaid EDI?

(800) 456-1242 (Nationwide Toll Free) Local: (334) 215-0111.

What is the phone number to apply for Medicaid in Alabama?

Apply online Call (800) 362-1504 (Toll-free) to find a location near you.

Does Alabama Medicaid have OTC benefits?

Brand preferred drugs, generics (some exceptions apply) and over-the-counter (OTC) drugs covered by Medicaid are available without prior approval. If a non-preferred drug is ordered, the practitioner will need to obtain prior authorization (PA).

How many prescriptions does Alabama Medicaid cover?

How many prescriptions can I get each month? Adult Medicaid recipients may get up to five total drugs (including up to four brand name drugs) per month. There are no limits on drugs for children.

Who is the PBM for Alabama Medicaid?

Alabama Medicaid does not utilize a Pharmacy Benefits Management vendor. However, Alabama does utilize a clinical contractor to compile the clinical review packet for each PT meeting. All financial and supplemental rebate matters are coordinated by Alabama Medicaid staff.

What is the phone number for Medicaid provider relations in Alabama?

Provider Enrollment Contact Information: (888) 223-3630 (Nationwide Toll-Free) Hours (All times Central) - Monday - Friday 8 a.m. to 5 p.m.

Does Medicaid of Alabama accept paper claims?

Claims Submission Methods Claims filed on paper must be submitted on a CMS-1500 claim form. Instructions for paper claim submission can be found in Chapter 5 of the provider billing manual.

Alabama Medicaid Prior (Rx) Authorization Form - eForms 2025

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