Prior Authorization Forms

Senior Whole Health requires you, or your physician, to get prior authorization for certain drugs. This means that you will need to get approval from Senior Whole Health before you fill your prescriptions. If you don't get approval, Senior Whole Health may not cover the drug.

The following document provides a list of drugs that require Prior Authorization.

Updated August 1, 2020

Download the Senior Whole Health 2020 Prior Authorization Criteria (PDF).

Download the Drug Coverage Determination Form (PDF) in ENGLISH.

Standard Prior Authorization Request Form (PDF)

Last Updated 08/01/2020