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 | Categories | Update Date | Download |
|---|---|---|---|
|
FDA Medwatch Form 1 645 downloads |
BCBSAL, BCBSFL, HiLab, sscripts | December 15, 2020 | Download |
|
General PA Request Form 1 2115 downloads |
BCBSFL | November 11, 2021 | Download |