Member Rights - Advance Determinations

How to Request an Advance Determination

Advance determinations are usually requested directly by your physician. However, if you need to submit a request yourself, have your doctor complete the appropriate form and mail or fax it to:

Pharmacy Review
P.O. Box 12485
Birmingham, AL 35202-2485

Fax: (205) 220-9575

For prescription drug advance determinations, please use the appropriate form below: This file requires Adobe PDF Reader. Scroll to the bottom of this page for a link to download the software.



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