Skip to main content

I Am a Provider Provider Portal Brokers

MyDHMP Portal Pay My Premium

Sitewide Navigation

EXPLORE PLANS
MEMBERS
RESOURCES
GET CARE
FIND A PROVIDER
CONTACT US

Sitewide Mobile Navigation

MyDHMP Portal Pay My Premium

EXPLORE PLANS
MEMBERS
FIND A PROVIDER
RESOURCES
GET CARE
CONTACT US
SEARCH

I Am a Provider Provider Portal Brokers

Pharmacy Prior Authorization Request Form

PDF Download

Click links below to download

Pharmacy Prior Authorization Request PDF Form - English
Pharmacy Prior Authorization Request PDF Form - Spanish

Home

MyDHMP Member Portal

Find a Provider

Health Insurance Glossary

Member FAQs

Wellness Blog

Member Newsletter

Contact Us

About Us

Quality Improvement

Statement About Incentives

Rights & Responsibilities

Annual Report

Member Advisory Council

Third Party Apps

DHMP Interoperability APIs

Non-Discrimination Notice

Compliance Program

Fraud, Waste & Abuse

Payment Integrity

Language Assistance

हिन्दी

Terms and Conditions of Use

Social Media Terms of Use

Adobe Acrobat is required to read PDFs

We use cookies to make interactions with our website easy and meaningful. By continuing to use this site, you are giving us your consent. Learn how cookies are used on our site.
Accept Terms