Authorization - Pharmacy
Tips for using eForms: 
- Fill out completely and submit it. You won't be able to start the form and save it for later.
- You can attach documents to support your request. Please have them ready.
- You'll be able to print a copy for your patient's medical record at the end.
Fax this form to 800-583-6289
For Blue Cross Blue Shield of MA employees, fax to 617-246-4013
For buy and bill option, fax to 888-641-5355
Fax this form to 800-583-6289
For Blue Cross Blue Shield of MA employees, fax to 617-246-4013
For buy and bill option, fax to 888-641-5355
Fax this form to 800-583-6289
For Blue Cross Blue Shield of MA employees, fax to 617-246-4013
For buy and bill option, fax to 888-641-5355
For Medicare prior authorization or formulary exception requests
