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Pharmacy prior authorization (PA)
You’ll want to ask for pharmacy PA when a medication isn’t on our preferred drug list (PDL). You’ll also need pharmacy PA if the medication has a utilization requirement. The Oklahoma Health Care Authority develops the PA criteria, as the Oklahoma Health Care Authority Drug Utilization Review (DUR) Board recommends.
Learn more about PA
Or call Provider Services at 1-844-365-4385 (TTY: 711). We’re here for you 8 AM to 5 PM, Monday to Friday.
Pharmacy PA guidelines
Pharmacy PA guidelines
You can review the state PA guidelines as well as our PA guidelines:
Guidelines for Universal Petition for Medication Authorization (PDF)
Guidelines for Opioid Morphine Milligram Equivalent Limit Override (PDF)
Electronic PA (ePA)
Electronic PA (ePA)
You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program.
With ePA, you can look forward to saving time with:
Less paperwork
Fewer phone calls and faxes
Quicker determinations
Safe and secure HIPAA-compliant submitted requests
Easy upload of clinical documents
Enroll now
Getting started with ePA is free and easy. You’ll need this info to enroll:
- BIN: 610591
- GRP: RX881G
- PCN: MCAIDADV
You can enroll two different ways:
Other ways to request PA
If you don’t want to enroll in ePA, you can request PA:
By phone
Call us at ${provider_services_phone}.
By fax
Check “PA request forms” in the next section to find the right form. Then, fax it with any supporting documentation for a medical necessity review to 1-888-601-8461.
PA Request forms
If you don’t see the right form in the list, you can use the Universal Petition for Medication Authorization (PDF). You may also need these forms:
Statement of Medical Necessity for Brand-Name Drug Override (PDF)
Step Therapy Exception (PDF)
Otherwise, check for the drug class or drug name that matches your needs:
Legal notices
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