Prior Authorization Forms for Caterpillar Prescription Drug Benefit Plans
Drugs listed below require a Prior Authorization for coverage determination. Under “Form,” click on the drug name to print the appropriate form, which should be completed, signed and faxed by the physician to the number shown at the bottom of the form. Incomplete forms will be returned to the physician, which will delay the coverage determination. Once a coverage determination has been made, the member and/or the physician will be notified.
Please refer to CatHealthBenefits.com each time a form is required. Forms are revised periodically.
* Refers to a drug that is not covered under all plans. Some drugs listed on the Prior Authorization page of CatHealthBenefits.com are not included in the drug formulary for certain salaried, management, non-bargained hourly employees and retirees. Please refer to the Complete Caterpillar Drug Formulary under the Drug Benefit tab on CatHealthBenefits.com to identify drugs that are covered under your prescription drug benefit, or contact RESTAT at 1-877-228-7909 to request a printed copy of the formulary.
+Indicates products processed through RESTAT for Health Alliance Medical Plan HMO participants only
