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Please respond below and fax this form to cvs. Web this patient’s benefit plan requires prior authorization for certain medications in order for the drug to be covered. Hawaii medicaid paper claims po box 967. _ *health plans may require additional information.
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This standardized prior authorization request form can be used for most prior authorization requests and use across all four health. 808.973.0676 (oahu) 888.667.0680 (ni) phone #: Web this web page provides a pdf form for hmsa quest prior authorization, a tool to request medication authorization from healthcare providers. Cvs caremark administers the prescription benefit plan for the patient identified.
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