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 file(s) 19 downloads |
BCBSAL, BCBSFL, HiLab, sscripts | December 15, 2020 | Download |
|
General PA Request Form 1 file(s) 48 downloads |
BCBSFL | December 4, 2020 | Download |