2017 Authorization Request Form

2017 Prior Authorization for Pharmacy (Last Updated November 01, 2017)

Many medications offered through Tribute require prior authorization to ensure for appropriateness and medical necessity. The link above will show the various categories of drugs requiring prior approval

2017 Step Therapy (Last Updated November 01, 2017)

Some medications require other medications to be used prior to another prescription. The link above indicated applicable medications.

2017 Quantity Limit Therapy (Last Updated November 01, 2017)

Filing a Claim Payment

Prior Authorizations by Service Level