Drug Authorization Forms

Please Note:

If you need drug authorization forms for Individual & Family Plans (OptimaFit), Optima Health Community Care, or Optima Medicare HMO please refer to the pages listed below for the proper forms.

Individual & Family Plans (OptimaFit)
Optima Health Community Care (OHCC/MLTSS)
Optima Medicare HMO

Pharmacy General Exception Forms

Maximum Daily Dosage Limit Exceptions Request Form
Pharmacy Medical Necessity Request Form
Pancreatic Enzyme Utilization Criteria for Cystic Fibrosis
Non-Formulary Exceptions Request

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Drug Authorization Forms

Pharmacy General Exception Forms

Drug Authorization Forms