BCBS of Alabama

To submit a prior authorization online, please click the button below to use the web form.

PDF forms are available below to submit a prior authorization through fax.

Title
Compounding Coverage Authorization Request Form
 1 file(s)  586 downloads

BCBSAL

November 16, 2016

Download

FDA Medwatch Form
 1 file(s)  1245 downloads

BCBSAL, BCBSFL, HiLab, HWMG, RxBenefits, sscripts

May 14, 2019

Download

FDA MedWatch Form 3500
 1 file(s)  174 downloads

BCBSAL

May 15, 2017

Download

General-PA Form
 1 file(s)  390 downloads

BCBSAL

August 17, 2020

Download

Opioid PA-Request Form
 1 file(s)  33 downloads

BCBSAL

August 17, 2020

Download

Part D Form
 1 file(s)  709 downloads

BCBSAL

November 16, 2016

Download

PCSI 10
 1 file(s)  8 downloads

BCBSAL

August 17, 2020

Download

Pegasys
 1 file(s)  4 downloads

BCBSAL

August 17, 2020

Download

Specialty Pharmacy Form
 1 file(s)  3351 downloads

BCBSAL

November 16, 2016

Download

Suboxone Subutex Prior Authorization Request Form
 1 file(s)  14 downloads

BCBSAL

August 17, 2020

Download

Substance Abuse Authorization Form
 1 file(s)  1 download

BCBSAL

August 17, 2020

Download

Synagis Authorization Request Form
 1 file(s)  116 downloads

BCBSAL

November 16, 2016

Download