Forms

Prior authorization and formulary exception form (PDF)
This form is also called the "Minnesota Uniform Form for Prescription Drug Prior Authorization Requests & Formulary Exceptions." Your doctor must complete and submit this form.

Request for prescription drug coverage exception External Link
You or your doctor may complete this electronic form to initiate any Formulary Exception, Prior Authorization, Quantity Limit override, or Step Therapy authorization request.

Prescription drug claim form External Link
You or your doctor may complete this electronic form to initiate any Formulary Exception, Prior Authorization, Quantity Limit override, or Step Therapy authorization request.