Pharmaceutical benefits can be complex, expensive, and fraught with requirements.
Phoenix PBM offers information, resources, and guidance to take the stress out of managing your benefits.
Our team spends every day focused on this industry. We translate that experience you in a way that is clear, specific to their needs, and actionable. Use the glossary to find terms and definitions that will help you understand your plan and ask informed questions. Use our claims evaluation tool to gain the confidence that you are getting the prescription benefits solutions you need at the fairest price.
Corporate Overview
Learn how Phoenix is simplifying complex healthcare solutions and creating successful, affordable prescription benefits programs for our clients and their customers.
Prior Authorization Forms
General PA Form
Opioid PA Form
ADHD PA Form
Diabetes PA Form
Acne Medications PA Form
Prior Authorization Requests/Updates
Please provide us with the completed Phoenix PBM Prior Authorization Form, it MUST include updated Clinical Notes and Diagnosis code. The form will be considered INCOMPLETE if clinical notes are not attached for review. Please fax directly to 888.835.3383
We will contact your office at the fax number listed on the form if we require additional information. Upon Approval/Denial of the drug we will fax back the notification to fax listed. Allow 24 to 48 hours to review information. Contact our Member Services Department if you have not received approval/denial within 48 hours after the completed form was submitted. Note: turnaround time may vary depending on the plan specifications.
Diabetes drugs:
INJECTIBLE ONLY-
Please provide us with the completed Prior Authorization Form, it MUST include updated Clinical Notes and Diagnosis code. A1C from the past 6-12 months must be included, if not, the prior authorization process will be delayed, and we will request them accordingly. The form will be considered INCOMPLETE if clinical notes and A1C’s are not attached for review. Please fax directly to 888.835.3383
Contracting
For Contracting inquiries please contact quality@phoenixpbm.com.
Pharmacy Provider Manual
Pharmacy Savings Card Program
Phoenix Benefits offers a pharmacy specific savings cards program for our network pharmacies. If you want a way to incentivize your cash paying patients, ask us about our program. We will structure the discounts specific to your needs and charge you a small per claim fee for the services.