Maryland Medicaid Pharmacy Preferred Drug List

Preferred Drug Fax Forms

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  • Click Here to view and copy the Prior Authorization Request Fax Form (For prescribers to use for faxing preauthorization requests) This is a .pdf file and requires Acrobat Reader

  • Click Here to view and copy the Medication Change Fax Form (For pharmacists to use to notify prescribers of preferred alternatives and preauthorization requirements) This is a Microsoft Word document

 

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