Submitting a PA request
Certain medications require approval, or prior authorization (PA), to ensure they are medically necessary, covered and appropriate for the reason prescribed. PA reviews are completed by clinical pharmacists and/or medical doctors.
Including supporting documentation for a PA
To ensure that a PA determination is provided to you in a timely manner, please submit all documentation needed to make a decision. Lack of information may delay the decision-making process and may result in an authorization denial unless all required information is received.
Get faster approval by submitting electronic prior authorizations
Providers who use an e-PA for medication requests, on average, spend 2.5 fewer hours on PAs per week2.
Electronic prior authorization (e-PA)
Benefits of using e-PA
- Real-time submissions at no additional cost
- Eliminates phone wait time and manual faxes
- Reduces disruptions to patient care
- Create renewals from previous submissions
- Clinical documentation can be submitted electronically
- Reduces paperwork and protects secure encrypted PHI3
Prior authorization resources for prescribers
Our three dynamic pharmacy solutions make it easy for your patients to get their medications, when and where they need them.
Electronic PA submission options:
Verbal PA submission option:
- Call 1-800-711-4555, option 2 to request a verbal prior authorization
5 a.m.–10 p.m. PT, Monday-Friday and 6 a.m.–3 p.m. PT, Saturday
Optum Infusion Pharmacy medical benefit coverage: please contact our Infusion Pharmacy team.
For Specialty and Infusion Pharmacies
Due to Medicare regulation 42 CFR § 423.566(c), CoverMyMeds® no longer allows specialty pharmacies to submit Medicare Part D to plans. Because of this, prescribers must submit the completed prior authorization to the plan.
Committed to getting patients on therapy fast
Optum will still do all the pharmacy work to create the PA. Once complete, we will share the request key for your review of the completed PA, so all you need to do is submit. All other plans will continue in the established process.
CoverMyMeds prior authorization process for Medicare Part D patients:
- Optum will create the PA in CoverMyMeds
- Optum will send you PA request key
- Prescriber visits: CoverMyMeds
- Prescriber enters the request key, patient last name and date of birth
- Prescriber reviews the PA and submits
- General PA Request Form
- Benzodiazepines
- Hospice form – Use this form for hospice enrollees
- Opioids (UnitedHealthcare Medicare only) - Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits.
- Opioids- Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits
- Prior Authorization Request Form (Emergient North Dakota Plan Only)
- Prior Authorization Request Form (Emergient Vermont Plan Only)
- Prior Authorization Request Form
- Healthcare Reform Copay Waiver Request Form
- Member Pays Difference Form (CalPERS Plan Only)
- Partial Copay Waiver Request Form (CalPERS Plan Only)
- Prescription Drug Reference Pricing Program (UFCW Plans Only)
- Prior Authorization Request Form
- Healthcare Reform Copay Waiver Request Form
- Delaware Prior Authorization Request Form
- Illinois Certification of Medical Necessity Form – ONLY FOR PROACTIVE REVIEW REQUEST PURSUANT TO PREVIOUS NOTICE RECEIVED.
- Rhode Island Prior Authorization Request Form
- UHC West of California delegated medical group auto-authorization form
- State of Arizona prior authorization form
- State of California prior authorization form
- State of Colorado prior authorization form
- State of Florida prior authorization form
- State of Illinois prior authorization form
- State of Louisiana prior authorization form
- State of Massachusetts general prior authorization form
- State of Massachusetts - Chemotherapy and Supportive Care prior authorization form
- State of Massachusetts - Hepatitis C prior authorization form
- State of Massachusetts - Synagis prior authorization form
- State of Michigan prior authorization form
- State of Minnesota prior authorization form
- State of New Hampshire prior authorization form
- State of New Mexico prior authorization form
- State of Oregon prior authorization form
- State of Texas prior authorization form
Our Utilization Management (UM) Program uses drug-specific PA guidelines to assess drug indications, set guideline types (step therapy, PA, initial or reauthorization) and determine approval criteria, duration, effective dates and more.
- Call 1-800-711-4555 to request Optum Rx standard drug-specific guideline to be faxed or mailed to you
Click here to review PA guideline changes.
You may request to discuss a prior authorization denial decision by contacting us at 1-800-711-4555.
- The ePA solution supports all forms of PA and formulary exception requests. Exclusions may include cost reduction requests such as tiering exception, copay waiver, and tier cost sharing. To submit these requests, please contact our PA department at 1-800-711-4555.
- Based on CoverMyMeds Industry Provider Survey.
- Provides secure transmission using the National Council for Prescription Drug Programs (NCPDP) standard.