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Highmark Provider Manual
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Requiring Authorization
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Pharmacy Prior Authorization Forms
Blood Disorders Medication Request Form
CGRP Inhibitors Medication Request Form
Chronic Inflammatory Diseases Medication Request Form
Dupixent Prior Authorization Form
Extended Release Opioid Prior Authorization Form
HHIC Request for Drug Coverage from Pharmaceutical Management Program
HHIC Specialty Drug Request Form
Medicare Part D Hospice Prior Authorization Information
Modafinil and Armodafinil PA Form
PCSK9 Inhibitor Prior Authorization Form
Request for Drug Coverage from Pharmaceutical Management Program
Short-Acting Opioid Prior Authorization Form
Specialty Drug Request Form
Testosterone Product Prior Authorization Form
Transplant Rejection Prophylaxis Medications
Weight Loss Medication Request Form
Last updated on 3/18/2021
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