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Medicare Part D PA forms

Member's ID indicates Medicare Part D coverage

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OptumRx (non-Medicare) PA forms

Member belongs to an OptumRx pharmacy plan

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UnitedHealthcare PA non-Medicare

OptumRx indicated as the pharmacy benefit manager

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Other PA forms

State specific fax forms or other universal fax forms

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Prescribers can submit requests to the OptumRx® prior authorization department by completing the applicable form (Part D, UnitedHealthcare or OptumRx) and faxing it to 1-800-527-0531.

For urgent requests, call 1-800-711-4555.

Hours:
5 a.m. PST to 10 p.m. PST, Monday through Friday
6 a.m. PST to 3 p.m. PST, Saturday