What is a Prior Authorization?

Certain medications have a status of Prior Authorization Required (PAR).  If your doctor wants to prescribe a PAR drug, he or she will submit a request for approval before the drug can be dispensed as a covered benefit.  If your pharmacist receives notification that a drug you were prescribed requires prior authorization, ask your pharmacist to contact us.

/resources/frequently-asked-questions

Prior Authorization/Clinical Criteria

Page with quarterly updates on changes to medical policies, drug formularies, and services requiring prior authorizations.

/policies/prior-authorization-clinical-criteria

Services Requiring Prior Authorization

Download our PDF for a complete list of services requiring prior authorization.

/resources/frequently-asked-questions

Prior Authorization Form

https://public.powerdms.com/PHPNI/documents/1242218

Authorization for Use and Disclosure of Protected Health Information

Specify who can receive your health information and exactly what information that they can receive with this simple form.

https://public.powerdms.com/PHPNI/documents/1451695

Authorization for Use and Disclosure of Protected Health Information

Specify who can receive your health information and exactly what information that they can receive with this simple form.

https://public.powerdms.com/PHPNI/documents/1451695

Utilization

PHP requires prior authorization for certain services that are provided to our members, including off-plan referrals. Please familiarize yourself with these services and requirements.

/providers/resources-for-providers/utilization

Pharmacy Prior Authorization Request Form

https://public.powerdms.com/PHPNI/documents/1461222

Medical Management Forms

Here's a quick link to the Prior Authorization Request form as well as out-of-network referral paperwork and more.

https://provider.phpni.com/forms