Massachusetts Standardized Prior Authorization Request Form

Submission instructions for the Massachusetts Prior Authorization Request Form

• Submit your Prior Authorization online via our web portal
• Click here to fill out the standard form request

Providers who wish to use the Massachusetts Standard Form for Medication Prior Authorization Requests may submit the form to Magellan Rx Management in one of the following 3 ways:

• Fax: 888.656.6671
• E-mail address:[email protected]
• Mail to:
  Magellan Rx Management
  c/o Authorization Request Department
  PO Box 1459
  Maryland Heights MO 63043