Medicare Part D Authorization Request Form

Medicare Part D, also called the Medicare prescription drug benefit Authorization Request Form

Medicare Part D Authorization Request Form authorizes someone else to take benefit of Medicare prescription drug benefit program. Complete the following medicare part D form to fax to 1-800-837-0959.

Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. To take benefit of this program you have to be a part of Medicare Part D program with a little monthly premium (which is auto-deductible from your social security payment).

Download Medicare Part D Authorization Request Form

Download Medicare-Part-D-Prior-Authorization-Request-Form-PDF.pdf (125KB)

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