Prior Authorization forms.
The Medication Request Form (MRF) is submitted by participating physicians and providers to obtain coverage for formulary drugs requiring prior authorization (PA); non-formulary drugs for which there are no suitable alternatives available; and overrides of pharmacy management procedures such as step therapy, quantity limit or other edits.
Health Care Providers
Prior Authorization Submission
FAX (858)790-7100
ePA submission
Conveniently submit requests at the point of care through the patient’s electronic health record.
If the EMR/EHR does not support ePA, you can use one of these vendor portals:
CoverMyMeds ePA portal
Surescripts Prior Authorizatio Portal