CIGNA Medication Prior Authorization Form


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Get your CIGNA Medication Prior Authorization Form in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What is CIGNA Medication Prior Authorization Form?

CIGNA medication prior authorization form was created by CIGNA HealthCare Pharmacy Services and is required by the company from its clients. It was made only for members of the agreement and partly covers the cost of prescriptions provided to clients by their doctors. Based on the contract they’ve signed with the company, the cost can be removed.

To check the discount you need to find out whether your insurance covers it. However, Cigna can’t simply give you the medications you want for free. The company has to make sure that these medications match your current health issues, they were prescribed by the doctor, and that they match the coverage of insurance.

CIGNA prior authorization form for medication can be filled online and sent by email. The company does not require the use of regular mail. You can even connect with the official representative of the company via phone and discuss the conditions.

CIGNA Medication Prior Authorization Form on PDFLiner

What I need the CIGNA Medication Prior Authorization Form for?

  • Members of Cigna insurance policy need medication prior authorization form to prove to the company that the medication he/she requires is part of the insurance. Only this way, the person can receive partly or full coverage of medication’s cost;
  • Cigna officials need the form to make sure that the patient is a member of the program and the insurance covers the particular medication that the person asks;
  • The insurance company has to contact a doctor to receive details on the patient’s health before the insurance is confirmed. You can use the document as a patient or as the representative of the insurance company to receive the treatment or to provide the appropriate treatment.

How to Fill Out CIGNA Medication Prior Authorization Form?

If you are looking for the Medicare prior authorization form for the medication you can go to the Cigna website and read the details on it. You will also find the form in PDF which you will be able to download on your device. However, without a specific third-party editor that works with the format you will not be able to fill the document online.

Since Cigna allows you to fill the form online and send it via email or fax you can use a PDF editor like PDFLiner to not only learn how to fill the document but also be able to complete it once you enter it. The form is simple and does not take much time to complete. After it, you can easily download the template on your device or send it to Cigna directly. Here is what you need to include in the Medicare medication prior authorization form PDF:

  1. Write down the information about the provider, including name, specialty, TIN, contact person in the office, phone number, fax, and address of the office;
  2. Provide information about the patient, including the name, ID in CIGNA, birth date, address, and phone number;
  3. Pick the appropriate statement in the medication request and diagnosis sections and put the tick in the box;
  4. Provide information on diagnosis if it is GERD, Ulcer, or Erosive Esophagitis.

CIGNA Medication Prior Authorization Form on PDFLiner

Organizations that work with CIGNA Medication Prior Authorization Form

  • CIGNA HealthCare Pharmacy Services;
  • Tel-Drug Inc.

Fillable online CIGNA Medication Prior Authorization Form
(4.9 / 5) 54 votes
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