We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Use our Preferred Drug List to find more information on the drugs that Ambetter covers.
- Prior Authorization Request Form for Non-Specialty Drugs
- Prior Authorization Request Forms for Specialty Drugs
Medical Pharmacy: Buy and Bill Services
- For medication administered at an office or facility and billed on a medical claim (CMS1500 or UB40), please submit authorization requests through Utilization Management using the GA Outpatient Prior Authorization Fax Form