Get Optumrx

Filling out the Optumrx form is essential for processing prior authorization requests for medications such as XR. This guide provides a step-by-step approach to help users complete the form accurately and efficiently, ensuring all necessary information is included.

Follow the steps to effectively complete the Optumrx form online.

1. Press the ‘Get Form’ button to access the Optumrx form and open it in your preferred editing tool.
2. Begin by entering the member information, including the member's full name, date of birth, and insurance ID number. Ensure all fields are filled out completely.
3. Next, fill out the provider information. This includes the provider's name, office phone, NPI number, street address, city, state, and zip code.
4. In the medication information section, provide the medication name, strength, and indicate if this medication is a new start. Include directions for use and dosage form.
5. Proceed to the clinical information section. Specify if this is a continuation of therapy and select the appropriate diagnosis. Include the relevant ICD-9/10 codes as necessary.
6. Indicate any previous medications the member has encountered failures, contraindications, or intolerances to by selecting the relevant options.
7. If applicable, fill out the quantity limit requests by stating the quantity requested per day and the reason for exceeding plan limitations.
8. Add any additional comments or important information that may support the request, as required by the form.
9. Once all information is entered, review the form for accuracy. Save any changes made, and choose to download, print, or share the completed form as needed.

Complete your Optumrx form online today for a smoother authorization process.