Pharmacy Forms
Online Submission
You can submit an online prior authorization request for any member who has Cigna prescription coverage. Submissions can be for prescription drugs covered either by the Cigna pharmacy benefit or the Cigna medical benefit.
View DocumentsMedicare Prescription Forms – PDP
Cigna offers Part D prescription drug plans to Medicare-eligible individuals.
View DocumentsMedicare Prescription Forms – MAPD
Cigna offers Medicare Advantage prescription drug plans to Medicare-eligible individuals
View DocumentsState Specific Forms
Certain states have required or suggested forms for requesting authorization for certain prescriptions. These would apply for individuals covered by an individual/family plan or through their employer.
View DocumentsCommercial Drug Prior Authorization Forms
These forms would apply for individuals covered by an individual/family plan or through their employer on a non-Medicare plan.
View DocumentsHome Delivery Pharmacy Forms
Use these forms to request prior authorization for a medication that will be filled by Cigna Home Delivery Pharmacy.
View Documents