Providers may submit prior authorization requests to UPMC Health Plan online or by fax.
- To submit a request online, please visit UPMC's PromptPA Portal.
- To submit a request via fax, please select the appropriate form below. These forms serve all UPMC Health Plan products unless specified otherwise.
We occasionally require additional information when completing a clinical review. If additional information is required, we will fax a letter to your office that details what additional information is needed.
If the requested information is not received back in a timely manner 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.
If you require a prior authorization for a medication not listed here, please contact UPMC Health Plan Pharmacy Services at 1-800-979-UPMC (8762).
If you are unable to locate a specific drug on our formulary, you can also select Non-Formulary Medications, then complete and submit that prior authorization form.