Request a prior authorization for a drug

Do you need to request a prior authorization (PA) for a prescription drug? Search for the right forms here.

MassHealth Customer Service Center for Providers

The Details of Request a prior authorization for a drug

How to request Request a prior authorization for a drug

  • You can use our Prior Authorization Forms for Pharmacy Services page to find the right PA form.
    • Search for the right form by either:
      • Using the drug search engine at the top of the page.
      • Selecting the first letter of the drug from the A to Z list up top.
      • Scrolling though the list to find the right form.
  • You can also go directly to the MassHealth Drug List A - Z tool to search by drug name.
  • You can also search for the right forms by using the Therapeutic Class Tables.
    1. Select the table class you need.
    2. Review the table and select the link to the PA form.

Contact for Request a prior authorization for a drug

Address
MassHealth Drug Utilization Review Program
P.O. Box 2586, Worcester, MA 01613-2586
Fax
Fax: (877) 208-7428

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