Patients with Medicare Part D Plans


Express Scripts is committed to helping you implement health plan prescription drug policies, including prior authorization.

For faster service, please submit your prior authorization request online.

Or call us at 800.935.6103.

If you are unable to use our Physician Coverage Review website or can't submit a request via telephone, please select the appropriate drug-specific request form from the list below and fax it to the number on the form.

Prior authorization request forms

Our drug-specific request forms cover many of the drugs commonly prescribed under our standard criteria. If you don't see the drug name you're looking for, use our general request form.