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



Children's Community Health Plan

PO Box 56099
Madison, WI 53705

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201


National Committee for Quality Assurance (NCQA) Accreditation

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