Bravo Health

Prior Authorization Information

Medical Prior Authorization Request Forms

Prior Authorization, Step Therapy & Quantity Limit Criteria

Coverage Determinations

Pharmacy Prior Authorization Request Forms

Please select the applicable Bravo Health Pharmacy Prior Authorization request form from the list below, fill it out, and fax it to:

• Fax: 1-866-464-0709
  Phone: 1-877-813-5595

For your convenience, Bravo Health Pharmacy Prior Authorization request forms are available for physician use only.