The prescribing practitioner will request prior authorization through the following procedure: A prescriber electing to order a drug requiring prior authorization may have any licensed medical personnel in their office call the Managed Access Program (MAP) Help Desk (1-800-344-9180) to request prior authorization. The prior authorization request may also be transmitted to the MAP Help Desk by FAX (1-800-250-6950) using the request form shown in the Appendices of the Pharmaceutical Services guide; The MAP Help Desk is available 24 hours a day, seven days per week. 

PA Request for Prescriber to fax in

The MAP pharmacist will ask for some or all of the following information, depending upon the class of the drug requested:
Client name and recipient ID number;
Diagnosis IDC-9-CM;
Drug name, strength, size and quantity of medication;
Medical justification for use of selected drug;
Pharmacy name and phone number (if available).

Pharmacists shall:
When the request is approved, the MAP Help Desk will notify the pharmacy when the dispensing pharmacy information is available. It is the pharmacist's responsibility to check whether the drugs are covered, whether the client is eligible, and to note restrictions such as date ranges and quantities before dispensing any medications that require prior authorization. The pharmacy should also check whether the client is enrolled in a managed care plan. An enrollment may have taken place after prior authorization was received; Prior authorization is given for a specific date of service and an NDC number or product; Able to fill the prescription at any Medicaid pharmacy provider.  There is no need for a prior authorization number; Emergency dispensing will be prior authorized for a seven-day supply for clients not enrolled in a managed care plan; If the prior authorization request has been denied, the MAP Help Desk will notify the pharmacy when the dispensing pharmacy information is available.