Provider Resources

Download the Prior Authorization Form

To request prior authorization, please click on the button to download our interactive and fillable Prior Authorization Form. Once the form is filled out in its entirety, please fax it back to AscendPBM Prior Authorization Department along with the patient’s lab work and clinical notes.

Fax the PA form back to (877)326-2856.

Click on the button to download our interactive & fillable Prior Authorization Form.

Download PA Form

To see if a medication is on the formulary for one of your patients or to check a list of preferred alternatives, please click the All Formulary button.

Please note: Contact the helpdesk to confirm which formulary your employer selected for your plan.

All Formulary

Together, it’s our shared mission to deliver quality patient care every time.

Join ASCEND’s preferred network offering access to more than 65,000+ pharmacies nationwide, including major chains, independent pharmacies, and retail locations. Our program combines one of the largest retail pharmacy chains in the nation with our integrated pharmacy care structure enabling us to capitalize upon multiple strengths to create innovative solutions for access, clinical care, and savings.

We review our network partners quarterly. If you would like to be considered, please complete the form below to get started.

Send any information or materials to be considered to info@ASCENDpbm.com ATTN: Pharmacy Credentialing.