Pharmacy

Rx prior authorizations

The Florida Medicaid (AHCA) Prior Authorization Criteria is located on the AHCA website.

For Magellan Complete Care Pharmacy Prior Authorizations please fax or mail completed forms to:

 

 Magellan Complete Care
 c/o Magellan Pharmacy Solutions
 11013 West Broad Street
 Suite 500
 Glen Allen, VA  23060

 Phone: 800-327-8613
 TTY: 800-424-1694
 Fax: 800-424-7982 

 

 

 

 

 

Forms

Generic Prior Authorization

 

Specialty Medications Prior Authorization

Request for Multi-Source Brand Drug

Abstral

Actiq

Albumin

Antidepressants - Under 6 years of age

Antipsychoic - Under 6 years of age

Antipsychoic - 6 to under 18 years of age

Aranesp

Botox

Cytogam

Fentora

Fuzeon

Hepatitis C

Increlex

Lazanda

Onsolis

Oral Oncology

Orfadin

Oxycodone

Panretin

Procrit

Proleukin

Provigil

Selzentry

Soma

Supprelin

Suboxone

Subsys

Synagis

Synagis - Weight change form

Tobi

Valcyte

VFEND

 

Diagnosis Forms

HIV diagnosis

Human growth hormone diagnosis

Neupogen leukine neulasta diagnosis

 

The Adobe Reader is required to view PDF files.