Request Prior Authorization - Express-Scripts.com

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Physicians, Streamline the Prior Authorization Request Process

Express Scripts is committed to helping you implement health plans' prescription drug policies, such as prior authorization. Our drug-specific request forms help simplify the process when your patient's plan requires prior authorization for a medication.

What kind of plan do you need to print an order form for?

For most health plans ...
Just select the drug name below, complete the form, and fax it to us at 800.357.9577.

For patients covered under WellPoint/Anthem insurance plans ...
Use WellPoint prior authorization forms.

We're Here to Help

Have an urgent request? Need information about a specific plan's PA criteria? Contact the Express Scripts Prior Authorization team at 800.417.8164.

Prior Authorization Request Forms

The forms below cover many of the most commonly prescribed drugs under our standard criteria (certain plans may require additional information). If you don't see the drug name you're looking for, use our general request form (PDF file).




PDF files require Adobe Acrobat Reader.