The Blue Cross and Blue Shield of Nebraska board of directors has named Jeff Russell as the company’s new president and CEO, effective June 26. Read more
Pharmacy Preauthorization Forms
Submit a pharmacy preauthorization by medication.
Submit a Pharmacy Pre-Authorization Online »
The below forms are available for providers that are unable to submit a preauthorization online through NaviNet.
- Acute CGRP Migraine updated 06/02/22
- Androgens updated 10/12/21
- Attention Deficit (Hyperactivity) Disorder (ADHD/ADD) updated 10/12/21
- Autoimmune Biologic Therapy updated 10/12/21
- Bowel Prep Cost Share Reduction updated 10/12/21
- Calcitonin Gene-related Peptide (CGRP) Inhibitor Migraine Prophylaxix updated 10/12/21
- Constipation Product updated 10/12/21
- Contraceptive Out-of-Pocket Reduction updated 10/12/21
- Dispense as Written – Prescriber Indicated Penalty Waiver Form updated 10/12/21
- General Medication updated 10/12/21
- Glucose Like Peptide-1 Agonists (GLP-1 Agonists) updated 10/12/21
- GI Protective NSAIDs updated 10/12/21
- Growth Hormone updated 10/12/21
- HCV updated 10/12/21
- HIV infection: Pre-exposure Prophylaxis (prep) medications updated 10/12/21
- HMG Co-A Reductase Inhibitor (Statin) updated 10/12/21
- Insulin updated 12/23/21
- IVIG updated 10/12/21
- Migraine Quantity Maximum updated 12/23/21
- Multiple Sclerosis updated 10/12/21
- Oral Acne Antibiotics updated 10/12/21
- Oral Fentanyl Quantity Maximum updated 10/12/21
- Oral Oncology Preauthorization Request Form updated 10/12/21
- LA Oxycodone updated 10/12/21
- Osteoporosis Treatments updated 10/12/21
- Proton Pump Inhibitors updated 10/12/21
- Retinoids (Topical Acne Agents) updated 10/12/21
- Risk Reduction for Primary Breast Cancer in Women updated 10/12/21
- Synagis updated 10/12/21
- Test Strips updated 10/12/21
- Xolair updated 10/12/21