Drugs listed on this page require prior authorization from Medicare.

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: