To submit a prior authorization online, please click the button below to use the web form.
Diabetic Glucagon-like peptide agonists (GLP-1) (Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza)
- Note: This is a closed formulary. Do not submit requests for NON-FORMULARY Adlyxin, Bydureon or Byetta. Non-formulary drugs are not subject to prior authorization review. Please submit questions to info@pcarx.com or fax to 210-624-8896.
Weight Loss Agents (generic stimulants, Qysmia, Saxenda, Wegovy)
- Note: This is a closed formulary. Do not submit requests for NON-FORMULARY Contrave or Xenical. Non-formulary drugs are not subject to prior authorization review. Please submit questions to info@pcarx.com or fax to 210-624-8896.
PDF forms are available below to submit a prior authorization through fax.