Prior Authorization Requests
Choose the submission method that works for your practice
VerusRx offers three ways to submit a prior authorization request.
Electronic prior authorization is the fastest option and provides real-time status updates, so we recommend it whenever possible.
1. Electronic Prior Authorization (ePA)
VerusRx has partnered with Surescripts® to offer ePA.
No login is required. After clicking the link above, select “Online Prior Authorization Form,” select the appropriate drug class or “Other” if the drug is not listed, complete all required fields, attach supporting documentation, then click Submit Request. You can download a PDF copy of the completed form for your records.
Please note: submissions through CoverMyMeds® cannot be accepted. You must use Surescripts for ePA or one of the alternative options below.
2. Online PA Webform
Submit your request online in minutes at
No login is required. After clicking the link above, select “Online Prior Authorization Form,” select the appropriate drug class or “Other” if the drug is not listed, complete all required fields, attach supporting documentation, then click Submit Request. You can download a PDF copy of the completed form for your records.
Fax
Please send your request via fax.
Fax the completed form and supporting medical records to our Prior Authorization team:
Phone: 833-225-1973