Our three dynamic pharmacy solutions make it easy for your patients to get their medications, when and where they need them.

Electronic PA submission options:

• CoverMyMeds
• Surescripts 

Verbal PA submission option:

• Call 1-800-711-4555, option 2 to request a verbal prior authorization
  5 a.m.–10 p.m. PT, Monday-Friday and 6 a.m.–3 p.m. PT, Saturday

• PreCheck Prior Authorization 1-sheet
• PreCheck Prior Authorization White Paper

• For Specialty and Infusion PharmaciesDue to Medicare regulation 42 CFR § 423.566(c), CoverMyMeds® no longer allows specialty pharmacies to submit Medicare Part D to plans. Because of this, prescribers must submit the completed prior authorization to the plan.Committed to getting patients on therapy fastOptum will still do all the pharmacy work to create the PA. Once complete, we will share the request key for your review of the completed PA, so all you need to do is submit. All other plans will continue in the established process.CoverMyMeds prior authorization process for Medicare Part D patients:
  1. Optum will create the PA in CoverMyMeds
  2. Optum will send you PA request key
  3. Prescriber visits: CoverMyMeds
  4. Prescriber enters the request key, patient last name and date of birth
  5. Prescriber reviews the PA and submits

• If you cannot submit requests to the Optum Rx® Prior Authorization Department through e-PA or telephone, please use one of the relevant forms below.Medicare Forms:
  • General PA Request Form
  • Benzodiazepines
  • Hospice form – Use this form for hospice enrollees
  • Opioids (UnitedHealthcare Medicare only) - Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits.
  • Opioids– Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits
  • Prior Authorization Request Form (Emergient North Dakota Plan Only)
  • Prior Authorization Request Form (Emergient Vermont Plan Only)

  Optum Rx (non-Medicare):

  • Prior Authorization Request Form
  • Healthcare Reform Copay Waiver Request Form
  • Member Pays Difference Form (CalPERS Plan Only)
  • Partial Copay Waiver Request Form (CalPERS Plan Ony)
  • Prescription Drug Reference Pricing Program (UFCW Plans Only)

  UnitedHealthcare (non-Medicare):

  • Prior Authorization Request Form
  • Healthcare Reform Copay Waiver Request Form
  • Delaware Prior Authorization Request Form
  • District of Columbia, Maryland, Minnesota, Mississippi, New Jersey, Oklahoma, Tennessee, Wyoming Prior Authorization Request Form
  • Illinois Certification of Medical Necessity Form – ONLY FOR PROACTIVE REVIEW REQUEST PURSUANT TO PREVIOUS NOTICE RECEIVED.
  • Rhode Island Prior Authorization Request Form 
  • UHC West of California delegated medical group auto-authorization form

  State-Specific PA Forms (Non-Medicare, Applies to Optum Rx and UnitedHealthcare):

  • State of Arizona prior authorization form
  • State of California prior authorization form
  • State of Colorado prior authorization form
  • State of Colorado – Serious Mental Illness Step Therapy Exception Form
  • State of Florida prior authorization form
  • State of Illinois prior authorization form
  • State of Louisiana prior authorization form
  • State of Massachusetts general prior authorization form
  • State of Massachusetts – Chemotherapy and Supportive Care prior authorization form
  • State of Massachusetts – Hepatitis C prior authorization form
  • State of Massachusetts – Synagis prior authorization form
  • State of Michigan prior authorization form
  • State of Minnesota prior authorization form
  • State of New Hampshire prior authorization form 
  • State of New Mexico prior authorization form
  • State of Oregon prior authorization form
  • State of Texas prior authorization form

• Our Utilization Management (UM) Program uses drug-specific PA guidelines to assess drug indications, set guideline types (step therapy, PA, initial or reauthorization) and determine approval criteria, duration, effective dates and more. 
  • Call 1-800-711-4555 to request Optum Rx standard drug-specific guideline to be faxed or mailed to you

• You may request to discuss a prior authorization denial decision by contacting us at 1-800-711-4555.