The Alliance uses a Medication Formulary to provide access to quality and clinically effective medications. Prescribers may submit a Prescription Drug Prior Authorization (PA) Request Form to request medication that are not on the Alliance Medication Formulary that requires a prior authorization (PA).

Prescribers must use the  Prescription Drug PA Request Form when submitting a request for review. The medications that require PA are subject to change.

PA requests encourages the appropriate and efficient use of medications by allowing coverage only when certain conditions are met.

The PA process is based upon current medical findings, FDA-approved manufacturer labeling information, and recommendations by the Alliance P&T Committee. The Alliance will review your request and make a decision within one (1) business day.

We are here to help

If you would like to discuss the decision with an Alliance medical director or receive a copy of a Prior Authorization Criteria, please call:

  • Alliance Pharmacy Services Department
  • Monday – Friday, 8 am – 5 pm
  • Phone Number: 1.510.747.4541

Pharmacy Benefit Manager (PBM)

The Alliance partners with PerformRx, a Pharmacy Benefit Manager (PBM). Exception requests will be routed to the Alliance from PerformRx. If you need help with prior authorizations, exceptions, medication formulary, and pharmacy network please call:

PerformRx
Monday – Friday, 8 am – 5:30 pm
Toll-Free: 1.855.508.1713