Medication Prior Authorization
- Drug Utilization
- Pharmacy Issues and Policy
- Pharmacy, Medications, Notices, etc. New.
- Prior Authorized Drug List
- Maximum Units
- Active Pharmaceutical Ingredients
- Interim Prior Authorization List
Amrixzz
Human Chorionic Gonadotropin (HCG)
Medicaid Naltrexone Prior Authorization Certification Form
Statins (HMG CoA Reductase Inhibitors) –
Suboxone and Subutex (Prior Authorization form listed below)
Synagis (Prior Authorization form listed below)
Medication Prior Authorization Form
Medication Prior Authorization Form – Free Text Form
Botulinum Toxin Prior Authorization Form
Suboxone and Subutex Prior Authorization form
Suboxone and Subutex Prior Authorization form – Free Text Form
Synagis Prior Authorization form
Synagis Prior Authorization form - Free Text 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).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
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