Medical Injectable Drug Forms
Last Updated: Friday, June 28, 2024
This page contains medical injectable drug authorization forms for providers to use when communicating with Highmark.
- wpa/ nepa
- cpa/ sepa
- de
- Medical Specialty Drug Authorization
- Outpatient Chemotherapy
- Outpatient Chemotherapy Aloxi
- Outpatient Chemotherapy Avastin
- Outpatient Chemotherapy Herceptin
- Outpatient Medical Injectable Botulinum Toxin
- Outpatient Medical Injectable Entyvio
- Outpatient Medical Injectable Evenity
- Outpatient Medical Injectable Granulocyte Colony-Stimulating Factors Filgrastim
- Outpatient Medical Injectable Granulocyte Colony-Stimulating Factors Pegfilgrastim/Eflapegrastim
- Outpatient Medical Injectable Infliximab
- Outpatient Medical Injectable Intra-Articular Hyaluronan Injections
- Outpatient Medical Injectable Intravitreal Injection
- Outpatient Medical Injectable Leqvio
- Outpatient Medical Injectable Monoclonal Antibodies For The Treatment Of Asthma And Eosinophilic Conditions
- Outpatient Medical Injectable Ocrevus
- Outpatient Medical Injectable Prolia
- Outpatient Medical Injectable Rituximab and Biosimilars
- Outpatient Medical Injectable Synagis
- Outpatient Medical Injectable Vyepti
- Outpatient Medical Injectable Xolair
- neny
- Medical Specialty Drug Authorization
- Outpatient Chemotherapy
- Outpatient Chemotherapy Aloxi
- Outpatient Chemotherapy Avastin
- Outpatient Chemotherapy Herceptin
- Outpatient Medical Injectable Botulinum Toxin
- Outpatient Medical Injectable Granulocyte Colony-Stimulating Factors
- Outpatient Medical Injectable Infliximab
- Outpatient Medical Injectable Intra-Articular Hyaluronan Injections
- Outpatient Medical Injectable Intravitreal Injection
- Outpatient Medical Injectable Monoclonal Antibodies For The Treatment Of Asthma And Eosinophilic Conditions
- Outpatient Medical Injectable Prolia
- Outpatient Medical Injectable Rituximab and Biosimilars
- Outpatient Medical Injectable Synagis
- wny
- Medical Specialty Drug Authorization
- Outpatient Chemotherapy
- Outpatient Chemotherapy Aloxi
- Outpatient Chemotherapy Avastin
- Outpatient Chemotherapy Herceptin
- Outpatient Medical Injectable Botulinum Toxin
- Outpatient Medical Injectable Granulocyte Colony-Stimulating Factors
- Outpatient Medical Injectable Infliximab
- Outpatient Medical Injectable Intra-Articular Hyaluronan Injections
- Outpatient Medical Injectable Intravitreal Injection
- Outpatient Medical Injectable Monoclonal Antibodies For The Treatment Of Asthma And Eosinophilic Conditions
- Outpatient Medical Injectable Prolia
- Outpatient Medical Injectable Rituximab and Biosimilars
- Outpatient Medical Injectable Synagis
- wv
Forms Removed
Effective July 1, 2024, West Virginia Law (Senate Bill 267) mandates the electronic submission of prior authorization requests. For this reason, Highmark removed West Virginia prior authorization forms from the Provider Resource Center (PRC). All prior authorization requests must now be submitted to Highmark via our provider portal (Availity®)
