WebHighmark Inc. or certain of its affiliated Blue companies also serve Blue Cross Blue Shield members in 29 counties in western Pennsylvania, 13 counties in northeastern Pennsylvania, the state of West Virginia plus Washington County, Ohio, the state of Delaware and 8 counties in western New York. All references to Highmark in this document WebJan 9, 2024 · Highmark West Virginia members may have prescription drug benefits that require prior authorization for selected drugs. Program designs differ. Call the Provider Service Center at 1-800-543-7822, for information regarding specific plans.
Medical Specialty Drug Authorization Request Form
WebImportant Legal Information: Highmark Blue Shield, Highmark Benefits Group, Highmark Choice Company, Highmark Senior Health Company, and/or Highmark Health Insurance Company provide health benefits and/or health benefit administration in the 21 counties of central Pennsylvania and 13 counties in northeast and north central Pennsylvania. WebMedical Specialty Drug Authorization Request Form . Please print, type or write legibly in blue or black ink. Once completed, please fax this form to the designated fax number for medical injectables at 833-581-1861. Authorization requests may alternatively be submitted via phone by calling 1-800-452-8507 (option 3, option 2). imdb tv shows i\u0027ve rated
Durable Medical Equipment (DME) Prior Authorization …
WebDec 30, 2024 · Requiring Authorization Pharmacy Policy Search ... Medical Injectable Drug Forms. Medical Specialty Drug Authorization; Outpatient Chemotherapy Aloxi (J1469) ... Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of … WebOct 24, 2024 · Addyi Prior Authorization Form. Blood Disorders Medication Request Form. CGRP Inhibitors Medication Request Form. Chronic Inflammatory Diseases Medication … Webq Non-Formulary q Prior Authorization q Expedited Request q Expedited Appeal q Prior Authorization q Standard Appeal CLINICAL / MEDICATION INFORMATION PRESCRIPTION DRUG MEDICATION REQUEST FORM FAX TO 1-866-240-8123 To view our formularies on-line, please visit our Web site at the addresses listed above. Fax each form separately. list of mozart piano sonatas