Electronic Prior Authorizations

For plans in Ohio and Minnesota, Providers may use SureScripts as a Prior Authorization Portal, which makes it easy for to submit fully electronic prior authorization requests right away.

There is no EHR needed, no technology integration, and no cost to providers — just quick and easy electronic prior authorizations.


You may also complete a  Prior Authorization Request Form to request a prior authorization. The Prior Authorization Request Form is to be used by providers to obtain coverage for a formulary drug requiring prior authorization (PA), a non-formulary drug for which there is no suitable alternative available, or any overrides of pharmacy management procedures such as step therapy, quantity limit or other edits. The form can be completed an faxed to (858) 790-7100.  Alternatively, a prior authorization request may be initiated by calling (800) 788-2949 with the information requested in the form.  If you have any questions regarding this process, please contact (800) 788-2949.

If you are looking for a state-specific prior authorization request form not listed below, additional forms can be found here: State-Specific PA Forms »

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