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Mohala Health GroupPractice Tools
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Prior Authorization and Formulary Finder

Look up whether a service or drug needs prior authorization for a Hawaiʻi health plan, and who handles it.

Nothing you type on this page is saved or sent. It stays in your browser until you close the tab.

Do not enter patient names, dates of birth, or member IDs. The printout has blank lines for those.

1. Medication

2. Diagnosis

3. Indication

Is this an FDA-approved indication?

4. Confirmatory testing

Is there confirmatory lab work or testing for the diagnosis on file?

5. What has been tried

List each drug tried for this diagnosis and why it stopped.

    6. Current medications

      7. Attestation

      I certify that the information above is true and accurate to the best of my knowledge.

      Medication prior authorization summary

      Patient name

      Date of birth

      Member ID

      1. Medication

      2. Diagnosis

      3. FDA-approved indication

      4. Confirmatory lab work or testing on file

      5. Tried for this diagnosis

      None listed

      6. Current medications

      None listed

      7. Attestation

      I certify that the information above is true and accurate to the best of my knowledge.

      Signature

      Date