Click below to access the PA/medical exception forms for these popular pharmacy benefit managers (PBMs) and healthcare plans.*
Call the Provider Services number on your patient’s healthcare plan or PBM card to verify if Prior Authorization (PA) is required for the medication your patient needs. If so, complete and submit the latest version of their PA form, which is usually found on the plan or PBM website. Examples of four PA forms are provided below for reference.
Blue Shield
North Carolina
Blue Cross
Blue Shield
Health Plans
Learn how the Extra Help program enhances Medicare Part D benefits for your eligible patients living with Parkinson’s in 2025—enabling them to fully leverage their plan for optimal care and support.
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