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Pharmacy Prior Authorization Forms If you require a prior authorization for a medication not listed here, please contact UPMC Health Plan Pharmacy Services at 1-800-396-4139. UPMC Health Plan makes all decisions on prior authorization requests within 24 hours from the time of initial review.
The requested information must be received within 24 hours of the original prior authorization request, or the request will be denied due to lack of sufficient information for review. The Health Plan will notify you of its prior authorization decision via fax on the date the actual decision is made. If your office is unable to receive faxes, you will be notified via U.S. mail. These forms serve all UPMC Health Plan products unless specified otherwise.
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