Pharmacy Authorizations
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Pharmacy Authorizations

Pharmacy Prior Authorization form

Please review the attached list to see if the medication requires a prior authorization and if it will be processed through the pharmacy or medical benefit.
Together with CCHP's Medication List

To view or print off a specific prior authorization form, click on the medication name below:

Medications A - M

Medications N - Z

 

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

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