Long Acting Sustained Release Opioid Prior Authorization (Pa) Request Form Page 2

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Provider Bulletin 2016-79
November 2016
page 2
Home page, go to Information > Publications >
Authorization/Certification Forms > Long
Acting Sustained Release Opioid PA Form; or
from the Home page, go to Pharmacy
Information > Pharmacy Program Publications
> Long Acting Sustained Release Opioid PA
Form.
The Pharmacy Web PA feature available on the
secure Web portal will be
updated in order to allow prescribing providers
to submit long acting sustained release opioid
PA requests in the near future.
Questions? Need assistance? Call the Provider Assistance Center Mon. – Fri. 8:00 a.m. – 5:00 p.m.
Toll free 1-800-842-8440 or write to Hewlett Packard Enterprise, PO Box 2991, Hartford, CT 06104
Program information is available at

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