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PHYSICIAN-ADMINISTERED Drug Prior Authorization for Individual and Family Plans

Individual & Family Rx Prior Authorization Forms

Rocky Mountain Health Plans cannot process prior authorization requests unless the physician sends clinical notes and indicated test results.  Failure to send clinical notes and test results will result in a timely denial of your request per Colorado State law. For medical drug criteria, please visit Exchange Plans Policies | UHCprovider.com.

IFP - Drug PA List

CO PA Form