Providers

Drug-Specific Pharmacy Prior Authorizations
Medicare Advantage

2026

Pharmacy Prior Authorization Requirements for Medicare

Drugs listed on this page require prior authorization under the Pharmacy benefit for Medicare Advantage.

2026 Pharmacy Prior Authorization Forms:

If you wish to prescribe a drug on this list, click on its name to download the associated prior authorization form in PDF format. Using the appropriate form will help to ensure that we have the information necessary to make a decision about your request.

Please note that there are different prior authorization forms for Medicaid, CHIP and Individual and Family Plans. To access those forms, visit the Medicaid and CHIP and the IFP pages.

Drug-Specific Pharmacy Prior Authorizations Medicare Advantage

2026

2026 Pharmacy Prior Authorization Forms:

Part D Step Therapy Authorization Forms

Part B Step Therapies

View 2025 Medicare Prior Authorizations

Drug-Specific Pharmacy Prior Authorizations
Medicare Advantage