Iowa has no single state-printed prescription drug prior authorization form for its insurance market. Instead, each pharmacy benefit manager operating in Iowa files the one prior authorization form it uses with the Iowa Insurance Division, which posts them on a public page. Prescribers use this index to find the form for the patient's PBM, such as CVS Caremark, Express Scripts, OptumRx or Prime Therapeutics, and send the request to that PBM.
The prescriber completes the form filed by the patient's PBM; the fields and layout vary from one PBM to the next. Patients do not complete a section.
Download the current version from the source each time; forms change without notice.
PBM Prior Authorization Forms (Iowa Insurance Division filed forms)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Not a single state form. Iowa law requires each pharmacy benefit manager to use one prior authorization form and file it with the Iowa Insurance Division, which publishes all of them in one place. The prescriber uses the form belonging to the patient's PBM.
Send it to the PBM named on the form, by fax or the other channel that PBM lists. The Iowa Insurance Division collects and posts the filed forms, but prior authorization requests themselves go to the PBM that manages the patient's prescription benefit.