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-
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- Pharmacy Formulary
- Formulary Changes for 2021
- Prescription Drug Prior Authorization
- Prior Authorization Criteria
- Anti-Obesity Agents Form
- Prior Authorization Information Request for Injectable Drugs
- Hepatitis C virus (HCV) Prior Authorization Checklist
- High Dose Opioid Regimen Checklist
- Synagis Statement of Medical Necessity
- Tobacco Treatment Checklist
- Treatment Authorization Request (TAR)
- Medical Nutrition Therapy Benefit Quick Reference Guide
- Pharmacy Home Program General Information and Enrollment Form
- Formulary Diabetic Testing Supplies Quick Reference Guide
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- Care-Based Incentive (CBI) Summary
- CBI Technical Specifications
- Antidepressant Medication Management Tip Sheet
- Immunizations: Adult Tip Sheet
- Immunizations: Adolescents Tip Sheet
- Programmatic Measure Benchmarks & Performance Improvement
- Asthma Medication Ratio Tip Sheet
- 90-Day Referral Completion – Exploratory Tip Sheet
- Antidepressant Medication Management Tip Sheet
- Application of Fluoride Varnish Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Chlamydia Screening in Women – Exploratory Measure Tip Sheet
- Child and Adolescent Well-Care Visits Tip Sheet
- Cervical Cancer Screening Tip Sheet
- Child and Adolescents BMI Assessment Tip Sheet
- Breast Cancer Screening – Exploratory Measure Tip Sheet
- Well-Child Visits in the First 15 Months of Life Tip Sheet
- Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
- Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet
- Preventable Emergency Visits Tip Sheet
- Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
- Maternity Care: Prenatal Tip Sheet
- Maternity Care: Postpartum Tip Sheet
- Plan All-Cause Readmissions Tip Sheet
- Lead Screening in Children – Exploratory Measure Tip Sheet
- Initial Health Assessment Tip Sheet
- Diabetic HbA1c Poor Control >9% Tip Sheet
- Developmental Screening in the First 3 Years Tip Sheet
- Controlling High Blood Pressure – Exploratory Measure Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Best Practices for Reducing Patient No-Shows Tip Sheet
- Ambulatory Care Sensitive Admissions Tip Sheet
- Depression Tool Kit
- USPSTF Recommendations for Primary Care Practice
- Emergency Care Visit Diagnosis
- Blood Lead Testing Flyer
- California Management Guidelines: Childhood Lead Poisoning
- Standard of Care Guidelines: Childhood Lead Poisoning
- What’s New
-
- Immunization Resources
- Member Incentives
- Value-Based Payments
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Home > For Providers > Manage Care > Pharmacy Services > Prescription Drug Prior Authorization or Step Therapy Exception Request Form
Manage Care
Prescription Drug Prior Authorization or Step Therapy Exception Request Form
Beginning April 1, 2021, prior authorization requests for all Alliance members must be submitted by completing the Prescription Drug Prior Authorization or Step Therapy Exception Request Form.
Click image below to open PDF file:
Contact Pharmacy Department
Phone: 831-430-5507
Fax: 831-430-5851
Monday-Friday, 8 a.m. to 5 p.m.
Provider Resources
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Provider Newsletter | Issue 17
July 15, 2021
Support Act Opioid Safety Edits
June 16, 2021
Alliance Provider Updates
June 14, 2021
June 2021 – Provider Bulletin
June 10, 2021
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