Get Optumrx Medication Prior Authorization Request 2019-2025

Completing the OptumRx Medication Prior Authorization Request online is a straightforward process that helps ensure the necessary medications are covered under your insurance plan. This guide provides clear, step-by-step instructions to assist users in filling out the form accurately and efficiently.

Follow the steps to complete the authorization request form.

1. Press the ‘Get Form’ button to obtain the request form and open it in your document editor.
2. Fill in the member information section, including the member's name, insurance ID, date of birth, and address. This information is crucial for identifying the user seeking medication coverage.
3. Complete the provider information section by entering the provider's name, NPI number, office phone, and fax number. Ensure all details are accurate to facilitate communication.
4. In the medication information section, input the medication name, strength, dosage form, check the box if requesting the brand, and provide directions for use.
5. Move to the clinical information section and answer all required questions regarding the patient's medication history, including whether this request is for continuation of therapy. It's crucial to provide documentation if the member has been on the requested medication within the last 180 days.
6. Document the diagnosis for the medication requested, including the ICD-10 code if available. Provide information on any medications the member has failed, including dates of trials.
7. Complete the prescriber attestation section, confirming that all information is true and accurate. The prescriber must sign and date this section.
8. Review all completed sections for accuracy and completeness. Ensure that any additional documentation required is attached.
9. Save changes to the form, and if necessary, download or print the completed document for submission. Share the form or fax it to the designated number for processing.

Complete your OptumRx Medication Prior Authorization Request online today for a smooth medication approval process.