PA Forms

Effective November 13, 2017, all pharmacy related calls (to include prior authorizations) will be handled by OptumRx. Member and eligibility questions will continue to be answered by South Dakota Medicaid.  The contact information for OptumRx is listed below:

  • Help Desk:                                                     (855) 401-4262                       Optum Rx
  • FFS Pharmacy Prior Authorization support:     (855) 401-4262                       Optum Rx
  • FFS Pharmacy Prior Auth. Fax Number:           (800) 527-0531                       Optum Rx 

All of the forms are in .pdf format. You must have Adobe Acrobat Reader to view the forms. If you do not have Adobe Acrobat Reader, we recommend downloading and installing the latest version.

 
 
 
 

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