Download Express Scripts Prior Authorization Fax Form | PDF

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Express Scripts Prior Authorization Fax Form | PDF


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Fax Form

General Fax Form – Send to 1-877-329-3760

1.800.753.2851

1.800.753.2851

The Express Scripts prior authorization fax form allows prescribers management over a patient’s prescription drug use and may request scripts by telephone, online, or fax.

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How to Request a Script

A prescription may be requested in any of the following ways;

  • Fax – 1-877-329-3760
  • Online – By logging-in and making the request.
  • Telephone – 1.800.753.2851

express-scripts-prior-authorization-fax-form

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