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Submitting a prior authorization request via fax forms


If you cannot submit requests to the OptumRx prior authorization department through electronic prior authorization or telephone, please select the applicable form (Part D, UnitedHealthcare or OptumRx) and fax to 1-800-527-0531.

Medicare Part D PA forms

Member's ID indicates Medicare Part D coverage

Select

UnitedHealthcare PA non-Medicare

OptumRx indicated as the pharmacy benefit manager

Select

OptumRx (non-Medicare)

Member belongs to an OptumRx pharmacy plan

Select

Other PA forms

State specific fax forms or other universal fax forms

Select