Pharmacy Prior Authorization
Providers are responsible for obtaining prior authorization. Providers may not bill members for services that require prior authorization and the authorization was not obtained, resulting in denial of the claim.
Authorization is not a guarantee of payment. Other limitations or requirements may apply.
How to submit a request for prior authorization
Online: Online pharmacy prior authorization
By phone: Call 1-866-610-2773
Fax: Fax to PerformRx at 1-866-610-2775
Effective August 25, 2017, prior authorization will no longer apply for medications with billed amounts of $250 or greater.
View list of HCPCS codes that require prior authorization (PDF)
Brand-name medications
To request prior authorization for brand-name medication when a generic is available, Select Health requires you to demonstrate that our member had an adverse reaction to a previously prescribed generic. You will also need to fill out a MedWatch adverse incident reporting form (PDF) and submit it to the U.S. Food and Drug Administration (FDA).
This requirement improves the safety of our members by ensuring that both Select Health and the FDA are notified of the adverse reaction. Please visit the FDA’s MedWatch page for more information and to complete submission of the form.
Download the MedWatch adverse incident reporting form (PDF)
Specialty and non-specialty prior authorization
Forms
- Long-acting opioid prior authorization form (PDF)
- Online pharmacy prior authorization form
- Short-acting opioid prior authorization form (PDF)
- Synagis prior authorization form (PDF)