2018 optumrx prior request-2026

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  1. Click ‘Get Form’ to open the 2018 OptumRx Prior Request in the editor.
  2. Begin by filling out the 'Member Information' section. Enter the member's name, insurance ID number, date of birth, and contact details including street address, city, state, and zip code.
  3. Next, complete the 'Provider Information' section. Input the provider's name, NPI number, office phone and fax numbers, along with their address details.
  4. In the 'Medication Information' section, specify the medication name and strength. Indicate if you are requesting a brand-name drug and provide directions for use and dosage form.
  5. Proceed to 'Clinical Information'. Answer all required questions regarding therapy continuation and previous medications tried. Ensure to document any relevant medical history.
  6. Finally, complete the prescriber attestation by confirming that all information is accurate. Sign and date where indicated before submitting your request.

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Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)
For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1027. Optum Rx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations.
Call Optum Rx at 1-844-368-8740. What do I do if my medication needs a PA? To begin the PA process, you can: Let your doctor know that a PA is needed for your medication. Call Optum Rx at 1-844-368-8740.
How long does prior authorization take? If you file an urgent request, we will have a decision provided in 72 hours or less. A standard non-urgent request may take up to seven days for us to make a decision. Learn more about the review of a non-covered drug, one not on our drug list.
How To Get Prior Authorization: Step-by-Step Guide Step 1: Check client eligibility. Step 2: Determine if a code or service requires Prior Authorization. Step 3: Find and complete forms. Step 4: Submit a PA request. Step 5: Check the status of an authorization.

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OptumRx Prior Authorization and Exception Request Procedures Call 1-800-711-4555 to submit a verbal PA request. View and print a PA request form.

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