Welcome to our Healthcare Providers page

At Fox Rx Care, we take our member's coverage personally.

This page contains links to documents you need to help our members receive the benefits for which they are entitled.

Scroll down to access links for formulary exception forms, prior authorization forms, redetermination request forms, and tier exception request forms.

If you have any questions, please send an e-mail to info@FoxRxCare.com or call our Customer Service team at 1-888-Fox-RxRx (1-888-369-7979)/ 1-888-369-7373. TTY callers should use 1-866-369-7373.

Prior Authorization Forms

Clinical Prior authorization request form

B vs D Prior Authorization Forms

Formulary/Tier Exceptions Forms

Step Therapy Exceptions Forms

Prior Authorization Forms

Clinical Prior Authorization Forms

• Prior authorization request form for Actimmune

• Prior authorization request form for ciclopirox nail lacquer

• Prior authorization request form for Cymbalta

• Prior authorization request form for Enbrel

• Prior authorization request form for Epogen, Procrit and Aranesp

• Prior authorization request form for Forteo

• Prior authorization request form for Humira

• Prior authorization request form for Itraconazole

• Prior authorization request form for Kineret

• Prior authorization request form for Lotronex

• Prior authorization request form for Provigil

• Prior authorization request form for Remicade

• Prior authorization request form for Revatio

• Prior authorization request form for Risperdal Consta

• Prior authorization request form for Singulair

• Prior authorization request form for Terbinafine

• Prior authorization request form for Xolair

B vs D Prior Authorization Forms

• Prior authorization request form for Cyclophosphamide

• Prior authorization request form for EmendOndansetronKytril

• Prior authorization request form for Engerix-B

• Prior authorization request form for ImmuneSuppressants

• Prior authorization request form for IVIG

• Prior authorization request form for NebulizerSolutions

• Prior authorization request form for ParenteralNutrition

Formulary/Tier Exception Forms

• Formulary exception request form

• Tier Exception request form

Step Therapy Exception Forms

• Step Therapy Exception Request Form for Atypical Antipsychotic

• Step Therapy Exception Request Form for COX-2

• Step Therapy Exception Request Form for HMG

• Step Therapy Exception Request Form for Nonsedating Antihistamine

• Step Therapy Exception Request Form for Opthalmic Prostaglandin Analogs

• Step Therapy Exception Request Form for Venlafaxine