To expedite the prior authorization process for our members who need a medication that requires prior authorization, we've included a list of forms for your use.

Please select and complete the appropriate form and fax it to Care Management at (816) 271-1228.

Prior Authorization Forms
Actiq
Migraine
Onychomycosis
Singulair
Wellbutrin
Xolair

Specialty Pharmacy Request Forms
General Specialty Pharmacy Form
Dermatology
Forteo
Hepatitis B and C
HIV
Multiple Sclerosis
Oncology
Rheumatology
Synagis