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
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
Non-Medicare (commercial) universal prior authorization form
Use this generic form if you are located in Arkansas or Mississippi or cannot locate an applicable drug-specific form. Urgent requests should be submitted via phone at 1-800-711-4555.