Search results with tag "Step therapy exception request"

Prescription Drug Prior Authorizathion Request Form - Aetna

Fax this form to: 1-877-269-9916 OR Submit your request online at: www.availity.com CALIFORNIA PRESCRIPTION DRUG PRIOR AUTHORIZATION OR STEP THERAPY EXCEPTION REQUEST FORM Patient Name: ID#: Instructions: Please fill out all applicable sections on both pages completely and legibly.

  Aetna, Step, Request, Therapy, Exception, Step therapy exception request