In the event your insurance requests a Prior Authorization to cover costs on your medication, please fill out the following form so that we have the information needed to apply for coverage. Once we have submitted the authorization request to your insurance for review, depending on your insurance it may take anywhere between 24 hours to a week (and sometimes longer) to receive a determination from them.

While waiting, consider checking GoodRX.com or the manufacturer’s website to find coupons/the best price for the medication.

Please make sure to provide information as it appears on your insurance card.