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HealthTrans' prior authorization guidelines are developed by our Pharmacy and Therapeutics Committee, and made available for download at anytime. Simply download the desired form below and fax the form back to us at 877-800-5633.
Acne Anemia Antibiotic Antifungal Arthritis Asthma Cervical Dystonia Crohn's Diabetes Eczema Fabry's Gaucher's Growth Hormone Hepatitis B Hepatitis C HIV/AIDS IBS Multiple Sclerosis Narcolepsy / Sleep Disorders Nausea Neutopenia Oncology Operational Osteoporosis Paget's Pain Inflammation Paroxysmal Nocturnal Hemoglobinuria Psoriasis Pulmonary Hypertension RSV Traveler's Diarrhea Weight Loss Wound Care
A Healthier Approach to Pharmacy Benefits 800.950.9120

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