Specialty Prior Authorization Forms
A – F
- Aranesp® request form (PDF)
- Biological (self-injectable) for arthritis request form (PDF)
- Biologicals (self-injectable) for psoriasis, psoriatic arthritis request form (PDF)
- Erythropoietin (Epogen®; monthly) approval form (PDF)
- Forteo®, Reclast®, Prolia®, or Boniva® injection request form (PDF)
G – I
- Growth hormone (patient self-administered) request form (PDF)
- Hemophilia drug request form (PDF)
- Hyaluronic acid derivatives (physician-administered) request form (PDF)
J – R
- Kuvan® request form (PDF)
- Long-acting injectable atypical antipsychotics request form (PDF)
- Myobloc®, Botox®, or Dysport® request form (PDF)
- Opioid Containing Products Request Form (PDF)
- Opioid dependence agents request form (PDF)
- Oral oncology medication request form (PDF)
- PROCRIT® request form (PDF)