PHARMACY PRIOR AUTHORIZATION
Prior authorization (PA) and Step Therapy (ST) requirements encourage safe, cost-effective medication use by allowing coverage when certain conditions are met. GlobalHealth benefits require covered medications to be prescribed in adherence to FDA-approved and manufacturer-recommended indications, strength, dosage, treatment duration, etc.
This page is for Commercial plans (Group Plans, State, Education, and Local Government plan and Federal Employee Health Benefits Program plan options only). For Generations Medicare Advantage plans, please call (866) 494-3927 or click here for Coverage Determination forms.
This general fax form should only be used when a drug specific form is not found. Using the General PA/ST fax form when a drug specific form is available may result in delays with processing your request.
Select a drug from the list below: