Last verified:

Enbrel Prior Authorization Resources

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

Brand Resources

See approval requirements for your carrier

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

Check coverage

Prior Authorization Forms

Sort by

Amerigroup

Last verified: Apr 10, 2026Amerigroup - Prior Authorization of Benefits Form

AmeriHealth Caritas Pennsylvania

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

Anthem Blue Cross Blue Shield Medicaid

Last verified: Apr 10, 2026Anthem Blue Cross Blue Shield Medicaid - Medicaid Managed Care Precertification Request

Anthem, Inc.

Last verified: Apr 12, 2026Anthem - Prior Authorization Form for Medical Injectables

Arkansas Blue Cross Blue Shield

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

Last verified: Apr 10, 2026Arkansas Blue Cross Blue Shield - Authorization and Organizational Determination Request

Blue Cross Blue Shield of Rhode Island, Inc.

Last verified: Apr 10, 2026Blue Cross Blue Shield of Rhode Island - Enrollment and Prior Authorization Form

Blue Cross of Idaho Health Services, Inc.

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

California

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

Capital District Physicians Health Plan, Inc.

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

CareFirst, Inc.

Last verified: Apr 10, 2026CareFirst BlueCross BlueShield - Prior Authorization Request

CareSource Management Group

Last verified: Apr 10, 2026CareSource - Medicaid Pharmacy Prior Authorization Policy

Cigna Corporation

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

Last verified: Apr 10, 2026Aetna - Immunologics Step Criteria - Medicare Advantage

Last verified: Apr 10, 2026Aetna - Medication Precertification Request

Hawaii Medical Service Association

Last verified: Apr 10, 2026Hawaii Medical Service Association - HMSACOM Prior Authorization Request

Health Partners Plans

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

Healthy Blue NC

Last verified: Apr 10, 2026Healthy Blue NC - Immunomodulators Prior Authorization

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

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

Indiana

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

Jefferson Health Plans

Last verified: Apr 10, 2026Jefferson Health Plans - Medicare 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

Last verified: Apr 10, 2026Kaiser Foundation Health Plans, Inc. - Virginia Medicaid FAMIS Prior Authorization Form Anti Inflammatory Tumor Necrosis Factor Inhibitor

Last verified: Apr 10, 2026Kaiser Permanente - HMO Exchange Prior Authorization Form

Last verified: Apr 16, 2026Kaiser Permanente - Maryland Health Choice Enbrel Prior Authorization Form

Last verified: Apr 16, 2026Kaiser Permanente - Mid Atlantic States HMO Enbrel Prior Authorization Form

Louisiana

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

Medical Mutual of Ohio Corporation

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

Last verified: Apr 10, 2026Medical Mutual of Ohio - Corporate Drug Policy - Etanercept Products

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

Last verified: Apr 12, 2026Molina Healthcare - Prior Authorization Criteria

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

Last verified: Apr 10, 2026MVP Health Care - Prior Authorization Request for Procedures and Services

Oregon

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

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

Sendero Health Plans

Last verified: Apr 10, 2026Sendero Health Plans - Prior Authorization Request

Texas

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

UnitedHealthcare

Last verified: Apr 12, 2026UnitedHealthcare - Prior Authorization Request

Last verified: Apr 10, 2026UnitedHealthcare - Exception to Rule Prior Authorization

US Family Health Plan

Last verified: Apr 10, 2026US Family Health Plan - Prior Authorization Request

Utah Medicaid

Last verified: Apr 10, 2026Utah Medicaid - Pharmacy Prior Authorization Request

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