Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP’s members.
Forms
- Direct Member Reimbursement Form (PDF)
- Alliant/MagellanRx Pharmacy Prior Authorization Form (PDF)*
- Alliant/MagellanRx Pharmacy Quantity Limit PA Form (PDF)
- Alliant/MagellanRx Step Therapy PA Form (PDF)
* Do Not Use this Form for Provider Administered Buy and Bill Medications
Drug List
Effective date: 10/1/2022 to 6/30/2023
- Generic Smart -Minimum Value Generics (MVG) Drug List
- Brand Wise- Minimum Value Brand (MVB) Drug List
Effective date on 7/1/2023 to 12/31/2023
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