The Medication Prior Authorization Program helps to ensure appropriate use
of medications. We do this so that our members can have continued access to
certain costly medications. Download
Medication Request Forms (MRF) and Clinical Criteria.
Medication Request Forms (MRF) should be submitted by physician providers to obtain coverage for drugs requiring prior authorization. Please complete the appropriate form and fax back to MedImpact Healthcare Systems at 858-790-7100. If you have any questions regarding this process, please contact MedImpact's Customer Service at 800-788-2949.
To discuss the clinical criteria used to determine authorization of these medications, please contact Pharmacy Services at 1-617-509-9060