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 Family Care (Medicaid Medallion 4.0)
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