Drug Prior Authorization Request Forms

Drug Prior Authorization Request Forms

If you need prior authorization for your prescription drugs, you can learn more about coverage determinations and find the forms you need.

Some prescription drugs may require prior authorization. Medicare refers to a prior authorization for prescription drugs as Drug Prior Authorization or Coverage Determination.

Customers

You or your prescriber may request a coverage determination for the prescribed medication. Without prior authorization, the drug may not be covered.

Providers

Forms must be completely filled out and returned to the Cigna Medicare Pharmacy department.

Use the search tool to look up medications by drug name or choose from 1 of the lists below.

Drug-specific forms should be used if provided. If no drug-specific form is given to you, please use:

Access the General Coverage Determination form - except Arizona

Access the General Coverage Determination form - Arizona only

Other non-specific drug forms:

Quantity Limit Exceeded Coverage Determination Form

Tier Exception Coverage Determination Form

Frequently Requested Drugs

Use this quick access list to find frequently used Prior Authorization Forms by drug name.

Opioids: Know the Risks

Our nation is facing an opioid epidemic. Because opioids carry such serious risks, Cigna and the Centers for Medicare & Medicaid Services (CMS) made important safety changes in 2019 to the prescription rules for Medicare customers.

Additional Plan Information

Drug List Formulary
See a comprehensive list of covered drugs.

Find Plan Documents
Go straight to the plan documents and information you need.

Provider and Pharmacy Directories
View our Medicare provider and pharmacy directories.

Premium Payment Options
Explore different options to pay your plan premium.

Find all your coverage information online

Log in to myCigna.com to view prescription coverage, find pharmacies, download forms, and more. Log in or register for access.