A prior authorization (PA) is required to ensure certain medications meet medical necessity guidelines. Your physician or provider must submit a medication request form to MedImpact for review before the prescription can be filled.

To obtain a PA for your medications:

• Your physician or provider can call MedImpact at (800) 788-2949 to request a prior authorization form or download the form below:
  Medication Request Form
• Your pharmacist can call MedImpact at (800) 788-2949 to request a prior authorization form be faxed to your physician or provider.

After the prior authorization process has been completed, you will receive a letter indicating the status of your PA. You can also check the status of a PA by calling MedImpact at (800) 788-2949.

The following medications require a Prior Authorization.
Changes to this list can occur at any time during the plan year.

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