Drug Prior Authorization Request

Online Drug Prior Authorization Request Form

To request a Prior Authorization for medicines not on CalOptima’s Approved Drug List, please complete this Online Drug Prior Authorization Request form or call our Customer Service department. If you have any questions, please contact our Customer Service department at 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday, from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-800-735-2929.

Please make sure you have a prescription from your doctor before filling out the Drug Prior Authorization Request Form. A prior authorization request cannot be completed if you do not have a prescription from your doctor.

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Summary Of Request


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