Pharmacy Prior Authorization

Online pharmacy prior authorization

The PerformRx^SM online prior authorization form is a prior authorization request form that providers complete online. Once you submit the form, your prior authorization requests are instantly submitted to PerformRx.

Submit online prior authorization

Benefits of the online prior authorization form

Save time by:

• Reducing prior authorization review time
• Giving instant approvals for specific drugs
• Attaching member-specific documents such as labs, chart notes, consults and more (formats: pdf, doc, xls, ppt, txt)
• Saving unique provider information to speed up future submissions
• Printing a summary page for easy reference

Questions?

Call PerformRx at 1-866-610-2773.