Friday, May 18, 2012
   
Text Size

Prior Authorization Forms

Documents can be ordered by Name (Alpha Ascending or Descending), Date Added or Number of Hits that the document has received to make it easier to find the document you want to download. Simply click on "Order By" Name, Date or Hits and "Ascendant" or "Descendent" and they will automatically repopulate accordingly.

Order by : Name | Date | Hits [ Ascendant ]

Xolair Xolair

Date added: 01/19/2012
Filesize: 28.92 kB
Downloads: 568

Viscosupplementation Viscosupplementation

Date added: 11/04/2011
Filesize: 27.99 kB
Downloads: 588

Victoza Victoza

Date added: 11/04/2011
Filesize: 42.28 kB
Downloads: 421

Tysabri Tysabri

Date added: 11/04/2011
Filesize: 27.39 kB
Downloads: 639

Thyrogen Thyrogen

Date added: 11/04/2011
Filesize: 26.95 kB
Downloads: 589

Synvisc Synvisc

Date added: 12/28/2011
Filesize: 27.99 kB
Downloads: 468

Synagis Synagis

Date added: 11/17/2011
Filesize: 42.9 kB
Downloads: 466

Symlin Symlin

Date added: 11/04/2011
Filesize: 39.97 kB
Downloads: 580

Supartz Supartz

Date added: 12/28/2011
Filesize: 27.99 kB
Downloads: 432

Suboxone/Subutex Suboxone/Subutex

Date added: 11/08/2011
Filesize: 50.91 kB
Downloads: 694

Simponi Simponi

Date added: 11/04/2011
Filesize: 26.07 kB
Downloads: 614

Sensipar Sensipar

Date added: 11/04/2011
Filesize: 32.6 kB
Downloads: 674

Revatio Revatio

Date added: 01/19/2012
Filesize: 38.37 kB
Downloads: 436

Remodulin Remodulin

Date added: 01/19/2012
Filesize: 38.37 kB
Downloads: 429

Remicade Remicade

Date added: 11/04/2011
Filesize: 25.75 kB
Downloads: 770

Reclast Reclast

Date added: 11/04/2011
Filesize: 32.85 kB
Downloads: 818

Rebif Rebif

Date added: 01/19/2012
Filesize: 28.64 kB
Downloads: 425

Raptiva Raptiva

Date added: 11/04/2011
Filesize: 25.31 kB
Downloads: 716

Pulmonary Hypertension Pulmonary Hypertension

Date added: 11/04/2011
Filesize: 38.33 kB
Downloads: 685

Provenge/Sipuleucel-T Provenge/Sipuleucel-T

Date added: 12/08/2011
Filesize: 29.83 kB
Downloads: 186
Page 1 of 3

Ohio Valley/Mountaineer Region
TF: 1.800.624.6961
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:30 am to 5:00 pm

HomeTown Region
TF: 1.800.426.9013
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:00 am to 5:00 pm