Prior Authorization

  • When a Medicare Prior Authorization (PA) is needed for a prescription, the member will be asked to have the physician or authorized agent of the physician contact our Prior Authorization Department to answer criteria questions to determine coverage.

     

    Please find below forms and information for these Medica health plans: Medica Prime Solution and Medica Advantage Solution.

     

    If you are a Minnesota physician, please submit your patient's prior authorization request using the Minnesota State PA Request Form.

     

    Medica Prime Solution

     

    Please use the Prime Solution Coverage Determination Request Form (prior authorization):

    Online form

    Print form

     

    To appeal a denied prior authorization, please use the Prime Solution Coverage Redetermination Request Form (redetermination):

    Online form

    Print form

     

    Prior Authorization

    Prior Authorization Criteria

     

    Step Therapy

    Step Therapy Criteria

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    Medica Advantage Solution

     

    Please use the Advantage Solution Coverage Determination Request Form (prior authorization):

    Online form

    Print form

     

    To appeal a denied prior authorization, please use the Advantage Solution Coverage Redetermination Request Form (redetermination):

    Online form

    Print form

     

    Prior Authorization

    Prior Authorization Criteria

     

    Step Therapy

    Step Therapy Criteria