Pharmacy Prior Authorization

Point of Sale (POS) Pharmacy Drug Prior Authorization Instructions – (click here for instructions)

Gainwell Technologies is the MS DOM vendor for Fee For Service drugs billed through the POS venue. If you are a Mississippi Medicaid prescriber, please submit your Fee For Service prior authorization requests through the Gainwell provider web portal, or please contact the Gainwell Pharmacy PA Unit at the following:

Please discard all old prior authorization packets printed prior to October 1, 2022 and utilize the new forms with updated contact information located in the drop-down menu below. 

For MSCAN drug prior authorizations, please click here for MSCAN plan prior authorization contact information.

Please utilize the drop-down menus below to select the appropriate PA packet.

Physician Administered Drug (PAD) Prior Authorization Instructions

Alliant Health Solutions is the current vendor responsible for prior authorization requests for fee-for-service (FFS) Medicaid beneficiaries. Please click here to direct you to the Alliant official website, or call Alliant directly at 1-888-224-3067.  Providers are encouraged to register with Alliant as soon as possible to submit authorization requests via the Alliant web portal. Drug criteria may be found on the Help/Support page.

• To determine whether Physician Administered Drugs require PA by Alliant, follow this link and search by procedure code: https://medicaid.ms.gov/procedure-code-pa-requirement/
  • Please note: This searchable procedure code PA listing includes all code types, not just drug codes.

Miscellaneous Forms

Pharmacy Reconsideration Request Form

MedWatch Form