Surescripts prior auth 2026

1. Click ‘Get Form’ to open the surescripts prior auth in the editor.
2. Begin by filling out the Provider Information section. Enter the prescriber name, specialty, identification number, fax, phone, and office contact name.
3. Next, complete the Member Information section with the member's name and date of birth. Ensure all details are accurate for smooth processing.
4. In the Drug Information section, specify the drug name and strength, dosage form, dosage interval, quantity per day, diagnosis relevant to this request, and expected length of therapy.
5. Answer the medication history questions carefully. Indicate if the member is currently treated on this medication and provide details as required.
6. In Section IV, provide a rationale for your request along with any pertinent clinical information that supports medical necessity.
7. Finally, ensure you sign and date the form before submitting it via fax or mail as instructed.

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