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Medication Prior Authorization

 

• Drug Utilization
• Pharmacy Issues and Policy
• Pharmacy, Medications, etc.
• Prior Authorized Drug List
• Maximum Units

Actiq

Amrix

Botox

Calcium

Duragesic

Ergocalciferol

Fexmid

Human Growth Hormone

Hydromorphone

Leuprolide

Long Acting Beta Agonist

Magnesium

Medicaid Naltrexone Prior Authorization Certification Form

Methadone

Oxy-IR

OxyContin

Panretin

Proton Pump Inhibitors

Quinine

Revatio

Soma

SR Opioids

Stadol

Symlin

Synagis (Prior Authorization form listed below)

Tekturna

Transderm Scop

Vitamin E

 

Prior Authorization general form 0707

Synagis Prior Authorization form

 

Prior Authorization Staff -

 

Please call Affiliated Computer Services, Inc: (907) 644-6800 or in-state toll-free number: (800) 770-5650.

Provider Inquiry/Provider Services: (907) 644-6800 (option 1) or toll-free: (800) 770-5650 (option 1, 1).

• For additional contact information, please visit the the Alaska Medicaid Assistance website

Clinical Call Center (MAP Desk)
1-800-331-4475
State of Alaska Health Care Services Pharmacy Medication Prior Authorization
1-888-603-7696 - fax

 

Technical Call Center
1-800-884-3238

 

Page updated 9/10/09