RxAdvance is now a part of nirvanaHealth. Click here to learn more.

Downloadable Forms (Prescribers)

General Prior Authorization Forms
Commercial Plan Prior Authorization FormClick here to download form
Medicare Prior Authorization FormClick here to download form
Drug Specific Prior Authorization Forms
Eucrisa (crisaborole)Click here to download form
Long-Acting Opioid AnalgesicsClick here to download form
Short-Acting Opioid AnalgesicsClick here to download form
Peer-to-Peer FormClick here to download form
Appeal Request FormClick here to download form
Request for PHI FormClick here to download form

Transform healthcare with us.

If you are interested in partnering with us on our mission to disrupt healthcare, reach out to our nirvana innovation team. We would love to hear any comments, questions, or feedback. 

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RxAdvance is now nirvanaHealth.

Since 2013, the RxAdvance team has been dedicated to disrupting the healthcare industry, specifically in pharmacy benefit management. After 3 years of development, we went live with our first client in 2016 and delivered groundbreaking pharmacy benefit management services. Now that we have proven success year-after-year, we have decided to expand our impact beyond just the PBM industry—onto the payer industry. These two industries alone control the majority of the healthcare spend in the United States, including the $900+ billion of waste generated annually. With our expansion into a new portion of the industry, we have outgrown the RxAdvance name, since it does not accurately capture the scope of our healthcare reach and mission. We are excited to announce our new name and brand—nirvanaHealth. The RxAdvance name has served us well for many years and will continue to do so under nirvanaHealth.