If you are a MS MEDICAID PRESCRIBER,
please submit your PA requests via the Envision Web Portal for most efficient processing.
If you are a MS MEDICAID PRESCRIBER, but are not a registered
MS ENVISION WEB PORTAL USER, click
here to register
If you are NOT a MS MEDICAID PRESCRIBER, please choose
applicable PA Form below and fax your request to DOM - Pharmacy PA Unit at 1-877-537-0720.
Upcoming Drug Prior Authorization Form Changes
– The 2013 State Legislature passed a bill that directs Health Insurance Issuers
and the Division of Medicaid to use a single, standardized prior authorization form
for obtaining any prior authorization for prescription drug benefits. The Pharmacy
Bureau is in the process of redesigning its prior authorization forms to meet the
criteria and provide a single form to use for all prior authorizations.
HB 301 Legislative Bill Summary