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Pdf forms are available below. Web to request precertification of therapy services, complete the appropriate form below and fax to the number given on the form. Your doctor will need to submit a prior authorization..

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Web doctor will need to submit a prior authorization request to prime therapeutics, which must be approved before you can continue to receive coverage for these drugs. Bluerx (pdp) is a medicare. To submit a prior authorization online, please click the button below to use the web form. Certain drugs require prior authorization to help promote safe, quality and affordable pharmacy care.

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