Prior authorization for prescribers

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

OptumRx® is going digital to simplify administrative activities for care providers, improve accuracy in the prior authorization (PA) process, and provide a better PA experience for both our providers and our members. Electronic prior authorizations (ePA) ensures an optimal experience for both members and providers. ePA simplifies the PA process and saves administrative time by making it easier to submit and track prior authorizations, and enables faster turnaround of coverage determinations. 

Please submit your prior authorization request to OptumRx® through any of the following online portals:

• General PA Request Form
  
• Benzodiazepines
• Hospice form – Use this form for hospice enrollees
  
• Opioids (UnitedHealthcare Medicare only) - Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits.
• Opioids- Please use this form for all opioid requests including MME exceeded, concurrent uses, quantity limits
• Tier Cost Form

• Prior Authorization Request Form 
• Healthcare Reform Copay Waiver Request Form
• Member Pays Difference Form (CalPERS Plan Only)
• Partial Copay Waiver Request Form (CalPERS Plan Only)
• Prescription Drug Reference Pricing Program (UFCW Plans Only)

• Prior Authorization Request Form
• Delaware Prior Authorization Request Form
  
• Illinois Certification of Medical Necessity Form – ONLY FOR PROACTIVE REVIEW REQUEST PURSUANT TO PREVIOUS NOTICE RECEIVED.
• Illinois Uniform Electronic Prior Authorization Form
  
• UHC West of California delegated medical group auto-authorization form

• State of California prior authorization form
• State of Colorado prior authorization form
• State of Louisiana prior authorization form
• State of Massachusetts general prior authorization form
• State of Massachusetts - Hepatitis C prior authorization form
• State of Massachusetts - Synagis prior authorization form
• State of Michigan prior authorization form
• State of Minnesota prior authorization form
• State of New Hampshire prior authorization form 
  
• State of New Mexico prior authorization form
• State of Oregon prior authorization form
• State of Texas prior authorization form