Prior Authorizations

Certain medications require a prior authorization to ensure that they are medically necessary and part of a specific treatment plan. Below are the prior authorization program guidelines:

The prescribing physician should notify ProCare Rx in advance about the medical condition that requires the use of drugs that appear on the prior authorization list; obtaining the authorization in advance will prevent delays at the pharmacy. ProCare Rx's staff is available at 1-800-662-0586 (8 AM to 8 PM, Monday through Friday) to provide immediate authorization. Once the drug is authorized, it can be filled at any participating pharmacy.

Physicians may fax prior authorization requests to 1-800-662-0590.

All Prior Authorizations have been approved by the ProCare Rx Pharmacy & Therapeutic Committee.

Filename Size
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An Adobe Acrobat file Androgel.pdf 79.68 KB
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An Adobe Acrobat file Anticoagulants.pdf 74.37 KB
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An Adobe Acrobat file Celebrex.pdf 80.38 KB
An Adobe Acrobat file Cimzia.pdf 82.5 KB
An Adobe Acrobat file Cometriq PA.pdf 80.54 KB
An Adobe Acrobat file Copaxone.pdf 76.33 KB
An Adobe Acrobat file Copegus, Rebetol, Ribasphere, Ribapak, Virazole, Ribavirin.pdf 192.8 KB
An Adobe Acrobat file Cox-II.pdf 80.77 KB
An Adobe Acrobat file Cyramza.pdf 189.25 KB
An Adobe Acrobat file Cystaran.pdf 121.92 KB
An Adobe Acrobat file Cytogam.pdf 77.02 KB
An Adobe Acrobat file Cytoxan.pdf 80.07 KB
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An Adobe Acrobat file Dexedrine Spansule.pdf 72.57 KB
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An Adobe Acrobat file Flumist.pdf 71.49 KB
An Adobe Acrobat file Forteo.pdf 76.23 KB
An Adobe Acrobat file Fuzeon.pdf 62.97 KB
An Adobe Acrobat file Gattex.pdf 78.96 KB
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An Adobe Acrobat file Orenitram.pdf 123.71 KB
An Adobe Acrobat file Orfadin.pdf 62.73 KB
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An Adobe Acrobat file Peg-Intron.pdf 73.02 KB
An Adobe Acrobat file Pegasys.pdf 72.47 KB
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An Adobe Acrobat file Penretin.pdf 61.49 KB
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An Adobe Acrobat file Restasis.pdf 75.78 KB
An Adobe Acrobat file Retin A.pdf 73.79 KB
An Adobe Acrobat file Revatio.pdf 77.37 KB
An Adobe Acrobat file Risperdal Consta.pdf 79.75 KB
An Adobe Acrobat file Rituxan.pdf 80.75 KB
An Adobe Acrobat file Roferon.pdf 83.71 KB
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An Adobe Acrobat file Signifor.pdf 80.06 KB
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