New Prescription Drug Prior Authorization or Step Therapy Request Form

Date: 09/28/17

The Department of Managed Health Care (DMHC) has updated the attached Prescription Drug Prior Authorization or Step Therapy Exception Request Form, also referred to as Form 61-211. Effective January 1, 2018, providers must use the updated Prescription Drug Prior Authorization or Step Therapy Exception Request Form for members with prescription medication benefits enrolled in Medi-Cal plans. The form must be completed and submitted for all medication prior authorization requests.  

On and after January 1, 2018, providers must submit prior authorization prescription requests on the updated form, or the request will be rejected. Also, on and after January 1, 2018, the previous version of the Prescription Drug Prior Authorization Request Form will no longer be accepted.

The form is available on our Provider Resources page.

All form fields must be completed in order for California Health & Wellness to process the request for authorization. Please note the contact information for submitting the form differs based on the type of prior authorization request being made. Instructions for submitting are included on the first page of the form.

Relevant sections of our provider manual have been revised to reflect the information contained in this update, as applicable. Provider manuals are also available on our website at the link above.

If you have questions regarding the information contained in this update, contact Provider Services at 1-877-658-0305.