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

Telligen is currently the vendor responsible for prior authorization requests. Please click here to search the Telligen prior authorization portal.

Miscellaneous Forms

Pharmacy Reconsideration Request Form

MedWatch Form