New Form Submission:
You can now fill out and submit your Prior Authorization and Override requests online.
Submit Request Online
Please select the desired link from the list below.
| Title | Categories | Update Date | Download |
|---|---|---|---|
|
Adult Growth Hormone Deficiency 1 file(s) 108 downloads |
ALPA | November 10, 2016 | Download |
|
AL Medicaid EPSDT Form 1 file(s) 1180 downloads |
ALPA | April 4, 2017 | Download |
|
AL Short Acting Opiate Naiive Days supply Limit Override 1 file(s) 445 downloads |
ALPA | February 15, 2019 | Download |
|
Biological Injectables 1 file(s) 1175 downloads |
ALPA | February 13, 2019 | Download |
|
Child Growth Hormone / Mecasermin 1 file(s) 33 downloads |
ALPA | November 15, 2016 | Download |
|
Child Growth Hormone Deficiency 1 file(s) 99 downloads |
ALPA | November 15, 2016 | Download |
|
Child Growth Hormone-Chronic Renal Insufficiency 1 file(s) 37 downloads |
ALPA | November 15, 2016 | Download |
|
Child Growth Hormone-Turner, Prader-Willi, Noonan 1 file(s) 30 downloads |
ALPA | November 15, 2016 | Download |
|
FDA MedWatch Form 3500 1 file(s) 532 downloads |
ALPA | May 15, 2017 | Download |
|
Hepatitis C Antiviral Medications 1 file(s) 162 downloads |
ALPA | July 2, 2020 | Download |
|
Hepatitis C Patient Consent Form 1 file(s) 94 downloads |
ALPA | March 27, 2017 | Download |
|
Miscellaneous 1 file(s) 937 downloads |
ALPA | November 15, 2016 | Download |
|
Opioid Dependence Treatment Agreement and Patient Consent Form 1 file(s) 428 downloads |
ALPA | June 21, 2017 | Download |
|
Opioid Dependence Treatment PA Request Form 1 file(s) 805 downloads |
ALPA | May 1, 2018 | Download |
|
Pharmacy Override 1 file(s) 3541 downloads |
ALPA | November 15, 2016 | Download |
|
Quit Now Alabama Referral Form 1 file(s) 840 downloads |
ALPA | March 27, 2017 | Download |
|
Quit Now Alabama Referral Form – Spanish 1 file(s) 37 downloads |
ALPA | May 1, 2018 | Download |
|
Simple PA Form 1 file(s) 6020 downloads |
ALPA | February 15, 2019 | Download |
|
Smoking Cessation 1 file(s) 554 downloads |
ALPA | May 12, 2017 | Download |
|
Synagis 1 file(s) 94 downloads |
ALPA | March 19, 2019 | Download |