Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
2026 Plan Publications
- 2026 Annual Notice of Changes (ANOC)
- 2026 Evidence of Coverage
- 2026 Comprehensive Formulary (effective March 1, 2026; last updated February 25, 2026)
- 2026 Prescription Drug Prior Authorization Criteria (effective March 1, 2026; last updated February 25, 2026)
- 2026 Prescription Drug Step Therapy Criteria (effective March 1, 2026; last updated February 25, 2026)
Provider Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory (last updated January 1, 2026)
- Part D Pharmacy Directory (last updated January 1, 2026)
| To report any errors in the PHP provider or pharmacy, please send an email to [email protected]. You may also report directory errors by calling Provider Relations at (888) 726-5411 between the hours of 8:00 am to 8:00 pm, Monday through Friday. |
- California Pre-Service Injectable Drug Authorization Request
- Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
- Medicare Outpatient Observation Notice (MOON)
(En Español, Large Print, MOON Instructions) - Prior Authorization Request Form
- Provider Claims Dispute Submission Form
- Prescription Drug Authorization Request
- Provider Grievance Form
- Ablative Techniques as a Treatment for Barrett’s Esophagus
- Acupuncture
- Clinical Practice Guidelines & Preventative Health Guidelines
- Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists
- Kidney Transplantation
- Liver Transplantation
- Outpatient Cystourethroscopy
- Pancreas Transplantation and Pancreas Kidney Transplantation
- PHP Clinical Practice Guidelines Preventative Health Guidelines
- Services Reviewed Using IQ
- Services Reviewed Using NCDs & LCDs
- Small Bowel, Small Bowel/Liver and Multivisceral Transplantation
- Standards of Care for the Health of Transgender and Gender Diverse People
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
Page Updated: March 25, 2026 @ 6:15pm