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Resources / Materials

Website Resources and Materials

  • Prior Authorization Form (PDF) (Please note: You cannot use this form for Medicare non-covered drugs: fertility drugs, drugs prescribed for weight loss, weight gain or hair growth, over the counter drugs, or prescription vitamins - except prenatal vitamins and fluoride preparations).
  • Solicitud de determinación de cobertura para medicamentos con receta de Medicare - Español (PDF) (Usted no puede utilizar este formulario para medicamentos de Medicare no cubre: medicamentos para la fertilidad, drogas recetadas para bajar de peso, peso crecimiento aumento o pelo, más los medicamentos de venta libre, o receta vitaminas (excepto vitaminas prenatales y preparados de fluoruro.)


(Please note: By clicking on the links below you will be leaving the Absolute Total Care website.)

If you have any questions, call Member Services at 1-855-735-4398. Hours are from 8 a.m. to 8 p.m., Monday through Friday.  After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

Last Updated: 03/01/2018