Prescription Drug Prior Authorization or Step Therapy Exception Request Form
Use this form to submit prescription drug prior authorization requests for Alliance Care IHSS members. Fax to MedImpact at (858) 790-7100. For any questions, contact MedImpact at (800) 788-2949.
For prescription drug prior authorization requests for Medi-Cal members, refer to www.Medi-CalRx.dhcs.ca.gov.
Click image below to open PDF file:
Contact Pharmacy Department
Monday-Friday, 8 a.m. to 5 p.m.