Physician Forms

To take advantage of electronic prior authorization (ePA), please submit your prior authorization request to Express Scripts online.

If you are unable to use our website, please call us at 800.753.2851 to submit a verbal prior authorization request, or you may submit faxed prior authorizations to 877.328.9799.

State Specific Prior Authorization Information

Arkansas, Illinois, Michigan, Oregon, and Vermont physicians can use this Prior Authorization form: Download now.

To view a list of drugs with a Prior Authorization requirement, click here.

State Specific Forms are available here:

Express Scripts Medicare Prescription Plan Resources

Access Medicare Part D Prior Authorization requests here.

Access additional Medicare Plan Member resources here.

BCBS of Louisiana

Call 800.842.2015 or Download form.