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Pharmacy Prior Authorization Request Form - AZBlue

www.azblue.com

Fax completed prior authorization request form to 602-864-3126 or email to pharmacyprecert@azblue.com. Call 866-325-1794 to check the status of a request. All requested data must be provided.

  Form, Request, Pharmacy, Authorization, Prior, Azblue, Pharmacy prior authorization request form

Blue Cross Blue Shield of Arizona’s Prescription Medication

fm.formularynavigator.com

forms, at azblue.com. Click on the “Resource Center” tab, select “Pharmacy” and select the “View resources for QHP Pharmacy Plans”. A non-formulary exception request does not guarantee approval. Drugs that are not on the formulary and have specific plan benefit exclusions will not be covered, such as weight loss products.

  Azblue

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