Pharmacy prior authorization
Online pharmacy prior authorization
The PerformRx online prior authorization form is a prior authorization request form that providers complete online. Once you submit the form, your prior authorization requests are instantly submitted to PerformRx℠.Submit online prior authorization
Having trouble using the online form? Download the printable prior authorization form (PDF).
Benefits of the online prior authorization form
Save time by:
- Reducing prior authorization review time
- Giving instant approvals for specific drugs
- Attaching member-specific documents such as labs, chart notes, consults and more (formats: pdf, doc, xls, ppt, txt)
- Saving unique provider information to speed up future submissions
- Printing a summary page for easy reference
Start using this form today and streamline your prior authorization requests.
- Take PerformRx's online prior authorization tutorial. This tutorial guides you through each step of the online prior authorization request process.
- Note: Please provide as much relevant medication information as possible. This will increase the accuracy of your submission. Incomplete forms will not be processed.
Call PerformRx at 1-866-610-2773.