Members and providers can search BMC HealthNet Plan Formulary for coverage of specific medications. If the provider feels that it is medically necessary for a member to take a medication belonging to a pharmacy program, he/she may submit a prior authorization request to the Plan by fax or online submission using the appropriate form below.

• If the request meets criteria, BMC HealthNet Plan will cover the drug.
• If the request is denied, the member and the authorized appeal representative have the right to appeal the decision.

Please review clinical guidelines before submitting prior authorization requests. Be sure to provide complete information on the form. Contact us with questions about guidelines, submitting forms, or to request a printed version of any guideline or form.