Get Cigna Medication Prior Authorization Form 2019-2026

This guide provides clear instructions for users on completing the Cigna Medication Prior Authorization Form online. Following these steps will help ensure that all necessary information is accurately submitted for the approval process.

Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling out the physician information section. Include the physician's name and specialty. Make sure to keep this information accurate for processing.
3. In the patient information section, complete all required fields, marked with an asterisk (*), which include the patient’s name, date of birth, Cigna ID, address, and phone number.
4. Indicate the urgency of the request by selecting either 'Standard' or 'Urgent.' If selecting 'Urgent,' add a note confirming that a delay could negatively impact the patient’s health.
5. Fill in the medication requested, detailing the name, strength, and dosing schedule of the medication, as well as the duration of therapy and quantity needed.
6. Describe the diagnosis related to the use of the medication. For pain medications, answer whether the patient has a terminal illness by selecting the appropriate option.
7. Complete the alternative medications section by indicating if the patient has previously received a generic alternative. Indicate any specific trials taken, detailing drug names, dates, and results, if applicable.
8. If the patient has tried other alternative treatments, provide the same level of detail as required for the previous section.
9. If no alternatives are available, provide reasons why the patient is unable to use them in the space provided.
10. Include any additional pertinent information that may support your patient’s request, such as clinical reasons and relevant lab values.
11. Once all fields are complete, review the form for accuracy and clarity. Save the changes, download, print, or share the completed form as needed.

Submit your completed Cigna Medication Prior Authorization Form online for a streamlined process.