Pharmacy Prior Authorization Process

Prior Authorization Process: The Alliance uses a Drug Formulary to provide access to quality and clinically effective medications. Prescribers may submit a Prior Authorization Form to request drugs that are on our Drug Formulary that requires a prior authorization. Prescribers MUST use this PA Form when submitting a request for review.  The medications that require prior authorization are subject to change.

  • Prior authorization encourages the appropriate and efficient use of medications by allowing coverage only when certain conditions are met.
  • The prior authorization process is based upon current medical findings, FDA-approved manufacturer labeling information, and recommendations by the Alliance's P&T (Pharmacy & Therapeutics) Committee.
  • The Alliance will review your request and make a decision within 1 business day.
  • If you would like to discuss the decision with an Alliance medical director or receive a copy of a Prior Authorization Criteria, please call the Alliance Pharmacy Services Unit at 510-747-4541.

Pharmacy Benefit Manager (PBM)

The Alliance partners with PerformRx, a Pharmacy Benefit Manager (PBM). Exception requests will be routed to the Alliance from PerformRx. Providers can contact PerformRx at 1-855-508-1713, Monday through Friday, 8:00 am - 5:30 pm if you need help with Prior Authorizations (PA), Exceptions, Drug Formulary, and Pharmacy Network.

For Pharmacy Questions

Contact the Alliance Provider Services department at 510-747-4510, Monday-Friday, 7:30 am - 5:30 pm.