PCA Rx

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

Formulary Glucagon-Like Peptide-1 (GLP-1) Agonists are listed below. This is a closed formulary. Non-formulary drugs are not subject to prior authorization review. Please submit questions to info@pcarx.com or fax to 210-624-8896.

For Diabetes: Exenatide, Liraglutide, Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza

For Weight Loss: Liraglutide, Wegovy, Zepbound

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

Title
FDA Medwatch Form
1 3048 downloads 		90degrees, affirmedrx, BCBSAL, BCBSFL, BCBSMN, Credence, Four Corners Health, HiLab, inscript, oreadrx, pcarx, rxsense, verusrx, wellyfe June 10, 2025 Download