Stay Updated on Priority Partners!

Pharmacy Compound Drug Prior Authorization Form

If your doctor is not able to substitute an ingredient in a medication or prescribe a different drug to you, they will need to fill out this form to request prior authorization for a compound drug.

Scroll to Top
Priority Partners members whose medical care is impacted by the recent collapse of the Francis Scott Key Bridge are encouraged to call our Customer Service team for assistance at 800-654-9728.
This is default text for notification bar