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Canasa Prior Authorization Resources

Get the latest prior authorization forms for Medicare, Medicaid, and commercial plans, as well as state and medication-specific forms.

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Prior Authorization Forms

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AllCare Health, Inc.

Last verified: Apr 10, 2026AllCare Health - Approval Criteria for 5-ASA Agents

AmeriHealth Caritas DC

Last verified: Apr 10, 2026AmeriHealth Caritas DC - Prior Authorization Criteria - Medications Without Drug-Specific Criteria

AmeriHealth Caritas Ohio

Last verified: Apr 10, 2026AmeriHealth Caritas Ohio - Prior Authorization Request Form

Arkansas Blue Cross Blue Shield

Last verified: Apr 15, 2026Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form

Blue Cross of Idaho Health Services, Inc.

Last verified: Apr 15, 2026Blue Cross of Idaho - General Prior Authorization Form

Buckeye Health Plan

Last verified: Apr 10, 2026Buckeye Health Plan - Clinical Policy Ulcerative Colitis Agents

California

Last verified: Apr 16, 2026California - Uniform Prior Authorization Form

California Department of Managed Health Care

Last verified: Apr 12, 2026California Department of Managed Health Care - Authorization or Step Therapy Exception Request Form

Capital District Physicians Health Plan, Inc.

Last verified: Apr 15, 2026CDPHP - General Prior Authorization Form

Central Health

Last verified: Apr 10, 2026Central Health - Prior Authorization Request Form

Cigna Corporation

Last verified: Apr 15, 2026Cigna - General Medication Prior Authorization Form

Last verified: Apr 10, 2026Cigna Corporation - Pharmacy Formulary Exception Form

Colorado

Last verified: Apr 16, 2026Colorado - Uniform Prior Authorization Form

Curative Health Insurance

Last verified: Apr 15, 2026Curative Health Insurance - Prior Authorization Form

CVS Caremark

Last verified: Apr 15, 2026Caremark - Formulary Exception and Prior Authorization Form

CVS Health (Aetna)

Last verified: Apr 15, 2026Aetna - Illinois Prior Authorization Request Form

Last verified: Apr 15, 2026Aetna - Medicare Prescription Drug Coverage Determination

Last verified: Apr 15, 2026Aetna - Arizona Prior Authorization Form

Last verified: Apr 15, 2026Aetna - Oregon Prior Authorization/Medical Exception/Precertification Form

Last verified: Apr 15, 2026Aetna - Louisiania Prior Authorization Request Form

Last verified: Apr 15, 2026Aetna - Medical Exception/Prior Authorization/Precertification Request for Prescription Medications

Last verified: Apr 15, 2026Aetna - Iowa Prior Authorization/Medical Exception/Precertification Request Form

Last verified: Apr 15, 2026Aetna - California Prior Authorization Form

Last verified: Apr 15, 2026Aetna - Texas Prior Authorization Form

Last verified: Apr 15, 2026Aetna - New Hampshire Prior Authorization Form

Harvard Pilgrim Health Care

Last verified: Apr 10, 2026Harvard Pilgrim Health Care - New Hampshire Uniform Prior Authorization Form - Prescription Drug Requests

Last verified: Apr 10, 2026Harvard Pilgrim Health Care - Massachusetts Standard Form for Medication Prior Authorization Requests

Health Net California

Last verified: Apr 10, 2026Health Net California - Prior Authorization Request - Managed Care Outpatient

Last verified: Apr 10, 2026Health Net California - Medi-Cal Fee-For-Service Prior Authorization Form

Health Partners Plans

Last verified: Apr 15, 2026Health Partners - General Prior Authorization Form

Humana, Inc.

Last verified: Apr 15, 2026Humana - General Prior Authorization Form

Illinois

Last verified: Apr 16, 2026Illinois - Uniform Prior Authorization Form

Independent Health Association, Inc.

Last verified: Apr 15, 2026Independence Health - Premium Formulary Prior Authorization Form

Last verified: Apr 15, 2026Independence Health - Select Formulary Prior Authorization Form

Last verified: Apr 15, 2026Independence Health - Value Formulary Prior Authorization Form

Last verified: Apr 15, 2026Independence Health - Medicare Part D Pharmacy Prior Authorization Form

Indiana

Last verified: Apr 16, 2026Indiana - Uniform Prior Authorization Form

Johns Hopkins HealthCare LLC

Last verified: Apr 10, 2026Johns Hopkins HealthCare - PPO Step Therapy Exception Form

Last verified: Apr 10, 2026Johns Hopkins HealthCare - Quantity Limit Exception Prior Authorization Form

Last verified: Apr 10, 2026Johns Hopkins HealthCare - USFHP Mesalamine Lialda Prior Authorization Form

Kaiser Foundation Health Plans, Inc.

Last verified: Apr 15, 2026Kaiser Permanente of Colorado - Medicare Medication Request form (MRF)

Last verified: Apr 15, 2026Kaiser Permanente of Colorado HMO - Uniform Pharmacy Prior Authorization Request Form

Kaiser Permanente Colorado

Last verified: Apr 12, 2026Kaiser Permanente Colorado - KPIC Prior Authorization Request Form

Louisiana

Last verified: Apr 16, 2026Louisiana - Uniform Prior Authorization Form

Massachusetts Executive Office of Health and Human Services

Last verified: Apr 10, 2026Massachusetts Executive Office of Health and Human Services - Massachusetts Standard Form for Medication Prior Authorization Requests

Medical Mutual of Ohio Corporation

Last verified: Apr 15, 2026Medical Mutual of Ohio - General Prior Authorization Form

Minnesota

Last verified: Apr 16, 2026Minnesota - Uniform Prior Authorization Form

Molina Health Care, Inc.

Last verified: Apr 15, 2026Molina - Ohio Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026Molina - Mississippi Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026Molina- Utah Medical Benefit Drug Prior Authorization Form

Last verified: Apr 15, 2026Molina - Utah Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026Molina - Idaho Medical Benefit Drug Prior Authorization Form

Last verified: Apr 15, 2026Molina - California Medical Benefit Drug Prior Authorization Form

Last verified: Apr 15, 2026Molina - Idaho Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026Molina - Wisconsin Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026Molina - Kentucky Pharmacy Prior Authorization Form

MVP Health Care, Inc.

Last verified: Apr 15, 2026MVP Health Care - NYS Medicaid Pharmacy Prior Authorization Form

Last verified: Apr 15, 2026MVP Health Care - Pharmacy Prior Authorization Form

New York FHSC

Last verified: Apr 10, 2026New York FHSC - NYRx Preferred Drug Program Preferred Drug List

NH Healthy Families

Last verified: Apr 10, 2026NH Healthy Families - Mesalamine Oral Therapy

Oregon

Last verified: Apr 16, 2026Oregon - Uniform Prior Authorization Form

Oscar Insurance

Last verified: Apr 10, 2026Oscar Insurance - Oscar IFP Prior Authorization List

Last verified: Apr 10, 2026Oscar Insurance - Mesalamine DR 800mg (Asacol HD) Clinical Guideline

PA Health and Wellness

Last verified: Apr 10, 2026PA Health and Wellness - Mesalamine Oral Therapy

Last verified: Apr 10, 2026PA Health and Wellness - Mesalamine Oral Therapy Clinical Policy

PacificSource Health Plan

Last verified: Apr 15, 2026Pacific Source - Medicaid Community Solutions Prior Authorization Form

Last verified: Apr 15, 2026Pacific Source - Pharmacy Prior Authorization Form

Premera, Inc.

Last verified: Apr 15, 2026Premera - Pharmacy Prior Authorization Form

Providence Health System

Last verified: Apr 15, 2026Providence Health Plan - Drug Prior Authorization Form

State of Arkansas

Last verified: Apr 10, 2026State of Arkansas - Arkansas Medicaid Prescription Drug Program Prior Authorization Request

Superior Health Plan

Last verified: Apr 10, 2026Superior Health Plan - Mesalamine (Apriso) Prior Authorization

Texas

Last verified: Apr 16, 2026Texas - Uniform Prior Authorization Form

Umpqua Health

Last verified: Apr 10, 2026Umpqua Health - Pharmacy Utilization Management Guidelines 2024

Last verified: Apr 10, 2026Umpqua Health - Pharmacy Utilization Management Guidelines 2025

UnitedHealth Group, Inc.

Last verified: Apr 10, 2026UnitedHealthcare - 2024 MA Formulary Prior Authorization

Washington

Last verified: Apr 16, 2026Washington - Uniform Prior Authorization Form

Wisconsin

Last verified: Apr 16, 2026Wisconsin - Uniform Prior Authorization Form

See approval requirements for your carrier

Find out what types of documentation and step therapies this carrier may require for coverage.

Check coverage