If you cannot submit requests through electronic prior authorization (ePA), or for urgent requests, please call us at 1-800-711-4555.
Hours: 5am PST to 10pm PST, Monday through Friday
Otherwise, you can submit requests to the OptumRx® Prior Authorization Department by completing and faxing the applicable form.
The hospice form should be used for hospice enrollees. Please complete this form along with a drug-specific form found below, when available.
Other Forms
- The General Form should be used when a drug-specific form is not available from the list above.
- Tier Cost Form
- Opioid Overrides (MME, 7 day supply limit, combination opioid use, duplicate long-acting opioid use) [UnitedHealthcare Medicare only]
- Opioid Overrides (MME, 7 day supply limit, combination opioid use, duplicate long-acting opioid use)
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