Vivid Clear Rx Prior Authorization Web Form
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Biologic Immunomodulators Initial
Biologic Immunomodulators Renewal
CGRP Inhibitors (Aimovig, Emgality, Ajovy) Initial
CGRP Inhibitors (Aimovig, Emgality, Ajovy) Renewal
Constipation Agents (Amitiza, Linzess, Trulance)
Glucagon-like peptide agonists (GLP-1) (Adlyxin, Bydureon, Byetta, Ozempic, Tanzeum, Trulicity, Victoza)
Opioids (Extended Release)
Opioids (Immediate Release)
Stimulants [Provigil (modafinil), Nuvigil (armodafinil)]
Topical products for atopic dermatitis [Protopic (tacrolimus), Elidel (pimecrolimus), Eucrisa]
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Other - Not Listed