Drug Prior Authorization Request Forms (Coverage Determinations)
Customers – For certain prescription drugs, Cigna-HealthSpring requires prior authorization. You or your prescriber may request a coverage decision or exception for the prescribed medication. Without prior authorization, the drug may not be covered.
Providers – Forms must be completed in their entirety and returned to the Cigna-HealthSpring Pharmacy department.
Use the search tool to look up medications by drug name or choose from one of the lists provided below.
Drug-specific forms should be used if provided. If no drug-specific form is available, please use the General Coverage Determination form.
Enter the drug name in the search tool and select the correct medication from the options listed to access the appropriate form.
Use this quick access list to find frequently used Prior Authorization Forms by drug name.