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Medications That Require Prior Authorization (O-Z)


Click on a link below to see a full list of forms available.
A-G  H-N  O-Z
Return to Authorization Forms

These forms are in portable document format (PDF). You may print and copy them as needed.

If the prescribed medication is not listed below please use the generic form (18 KB PDF).

  • Oforta
  • Targretin
  • Onsolis
  • Tasigna
  • Peg-Intron
  • Tobi
  • Pegasys
  • Tracleer
  • Prevacid SoluTab
  • Tykerb
  • Procrit
  • Tyvaso
  • Provigil
  • Vectical
  • Razadyne
  • Ventavis
  • Rebetron
  • Vesanoid
  • Regranex
  • VFend
  • Relistor
  • Viagra
  • Revlimid
  • Victoza
  • Roferon
  • Vimpat
  • Sabril
  • Vivaglobin
  • Sancuso
  • Votrient
  • Simponi
  • Xeloda
  • Sporanox
  • Xenazine
  • Stimate
  • Xifaxan
  • Subutex/Suboxone
  • Xyrem
  • Sutent
  • Zemplar
  • Taclonex
  • Zortress
  • Tarceva


  • Return to Authorization Forms


     
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