Is there a separate MedImpact fax number for Medicare Part D?

MedImpact uses the same fax number for Medicare Part D as for its commercial form, 858-790-7100. The Part D form, Request for Medicare Drug Coverage Determination, also lists the mailing address 10181 Scripps Gateway Court, San Diego, CA 92131 and says to submit by mail or fax. MedImpact's Nebraska and Kentucky Medicaid state forms print different numbers.

How do I mark a MedImpact request as urgent?

Check the Urgent box on the MedImpact Standard Medication Request Form, which reads 'Check the box if the request is URGENT.' MedImpact puts the box on the page for the prescriber to check on the July 2026 version (07-28-26), and the signed form then goes by fax to 858-790-7100.

Which MedImpact fax number goes with the Nebraska and Kentucky forms?

Nebraska's Standard Prior Authorization Request, a Nebraska Department of Insurance form effective January 1, 2026, says to fax the completed form to MedImpact Healthcare Systems, Inc. at 858-621-5147, which MedImpact's Contact Us page calls the Corporate Fax. The Kentucky Medicaid Pharmacy Prior Authorization Form (Rev. 04.27.2021) prints 858-357-2612 beside its MCO Member and FFS Member plan rows.

October 23, 2026

MedImpact prior authorization fax number (2026)

MedImpact's prior authorization fax number is 858-790-7100 on its July 2026 Medication Request Form and Part D form. Nebraska's form prints 858-621-5147 and Kentucky Medicaid's form 858-357-2612.

A pharmacist in scrubs checking stocked medication shelves

MedImpact's prior authorization fax number is 858-790-7100, printed on its Standard Medication Request Form and its Prior Authorization Documents page. The Medicare Part D form, Request for Medicare Drug Coverage Determination, goes by mail to 10181 Scripps Gateway Court, San Diego, CA 92131 or by fax to the same 858-790-7100.

What is the MedImpact prior authorization fax number?

MedImpact prints its prior authorization fax number as (858) 790-7100 on the Standard Medication Request Form, version dated 07-28-26, and as 858-790-7100 on its Medicare Part D form. The Prior Authorization Documents page shows FAX (858)790-7100, and the Contact Us page lists the same number with a link to download forms, both under Prior Authorization Submission for health care providers. The Nebraska and Kentucky Medicaid state forms print other numbers, as the table shows:

MedImpact fax number	Form and benefit it serves
858-790-7100	Standard Medication Request Form, MRF (Prior Authorization Request Form), for commercial and other non-Part D plans, version dated 07-28-26
858-790-7100	Medicare Part D: Request for Medicare Drug Coverage Determination (Part D Standard MRF), by mail to 10181 Scripps Gateway Court, San Diego, CA 92131 or by fax
858-790-7100	New Mexico Medication Request Form (state form), which says to file via facsimile
858-790-7100	North Carolina Medicaid Standard Drug Request Form (state form posted August 2026)
858-621-5147	Nebraska Standard Prior Authorization Request (Nebraska Department of Insurance form, effective January 1, 2026): fax the completed form to MedImpact Healthcare Systems, Inc.; the Contact Us page calls this number the Corporate Fax
858-357-2612	Kentucky Medicaid Pharmacy Prior Authorization Form (Rev. 04.27.2021), printed in the Fax number column beside the MCO Member and FFS Member plan rows

The Contact Us page calls 858-621-5147 the Corporate Fax, and the Nebraska form is the one in the table that sends prior authorization requests there. A state form takes the number printed on it, even where it differs from the commercial form.

Is there a different MedImpact fax number for Medicare Part D?

MedImpact's Medicare Part D form prints the same fax number as its commercial form, 858-790-7100. The form, Request for Medicare Drug Coverage Determination (the Part D Standard MRF), says to submit by mail or fax and lists the address 10181 Scripps Gateway Court, San Diego, CA 92131, the same address the Standard Medication Request Form lists. It carries supporting-information pages for the prescriber. A Part D formulary or tiering exception also needs the prescriber's supporting statement, and the decision clock that follows is in the Part D formulary exception guide.

What goes on a MedImpact Medication Request Form?

The MedImpact Standard Medication Request Form is for prescribers only and requires the prescriber's signature, in the July 2026 version dated 07-28-26. MedImpact's Medication Request Form covers overrides of step therapy, quantity limits and other edits. Commercial and other non-Part D plans use the Standard form, Medicare Part D uses its own, and New Mexico, North Carolina Medicaid, Nebraska and Kentucky Medicaid have state forms.

Preauthorization is a payment activity under HIPAA (45 CFR 164.501), so the minimum necessary standard (45 CFR 164.502(b)) applies to the supporting information that goes with the form.

How do you mark a MedImpact request urgent?

A MedImpact request is marked urgent with the Urgent box on the Standard Medication Request Form, which reads "Check the box if the request is URGENT." The prescriber checks the box on the July 2026 version before the form is faxed to 858-790-7100. How to request an expedited prior authorization covers how urgent requests run across plans and pharmacy benefit managers.

How do you fax MedImpact from a HIPAA fax account?

A prescriber's office can send the signed MedImpact form straight from a browser or an email with a HIPAA fax account, to 858-790-7100 or to the state number its form prints. Fax Pigeon makes the cover sheet optional, so MedImpact's form can be the first page MedImpact sees, and any PDF, Word, Excel or PowerPoint file or phone photo goes up as it is. Every fax that arrives gets delivery proof, which belongs in the request file, and on paid plans the practice sends and receives from its own number. Basic runs $4.99 a month billed annually for 200 pages, and on every plan the BAA is signed during signup and adding a person costs nothing.

What if the MedImpact fax fails or the number changes?

MedImpact's forms print three different fax numbers, so a MedImpact fax that shows no delivery proof starts with a check of the number dialed against the form being sent: the commercial, Part D, New Mexico and North Carolina Medicaid forms print 858-790-7100, Nebraska's form prints 858-621-5147 and the Kentucky Medicaid form prints 858-357-2612. MedImpact's Prior Authorization Documents page, named in the footer, holds the current forms to confirm against before protected health information goes out. The forms in the table range from a Kentucky Medicaid revision dated 04.27.2021 to a North Carolina Medicaid form posted in August 2026, so a copy saved before a revision can show an old number.

Other pharmacy benefit managers print their own numbers on their own forms. The OptumRx prior authorization fax number and Express Scripts prior authorization fax number pages cover two of them.

* Fax numbers verified October 23, 2026, on MedImpact's own MedImpact Prior Authorization Documents (https://www.medimpact.com/Prior-Authorization-Forms) and MedImpact Standard MRF (07-28-26) (https://www.medimpact.com/sites/default/files/2026-09/MedImpact%20Standard%20MRF%2007-28-26.pdf).

Frequently asked questions

What is the MedImpact prior authorization fax number?: MedImpact's prior authorization fax number is 858-790-7100. The number appears as (858) 790-7100 on the Standard Medication Request Form dated 07-28-26, as FAX (858)790-7100 on the Prior Authorization Documents page and as 858-790-7100 on the Part D form. Nebraska's state form prints 858-621-5147, and the Kentucky Medicaid form prints 858-357-2612.
What form do I fax to MedImpact for prior authorization?: Fax the MedImpact Standard Medication Request Form, also called the Prior Authorization Request Form, for commercial and other non-Part D plans. The July 2026 version is for prescribers only and requires the prescriber's signature. Medicare Part D uses the Request for Medicare Drug Coverage Determination, and New Mexico, North Carolina Medicaid, Nebraska and Kentucky Medicaid have state forms.
Is there a separate MedImpact fax number for Medicare Part D?: MedImpact uses the same fax number for Medicare Part D as for its commercial form, 858-790-7100. The Part D form, Request for Medicare Drug Coverage Determination, also lists the mailing address 10181 Scripps Gateway Court, San Diego, CA 92131 and says to submit by mail or fax. MedImpact's Nebraska and Kentucky Medicaid state forms print different numbers.
How do I mark a MedImpact request as urgent?: Check the Urgent box on the MedImpact Standard Medication Request Form, which reads 'Check the box if the request is URGENT.' MedImpact puts the box on the page for the prescriber to check on the July 2026 version (07-28-26), and the signed form then goes by fax to 858-790-7100.
Which MedImpact fax number goes with the Nebraska and Kentucky forms?: Nebraska's Standard Prior Authorization Request, a Nebraska Department of Insurance form effective January 1, 2026, says to fax the completed form to MedImpact Healthcare Systems, Inc. at 858-621-5147, which MedImpact's Contact Us page calls the Corporate Fax. The Kentucky Medicaid Pharmacy Prior Authorization Form (Rev. 04.27.2021) prints 858-357-2612 beside its MCO Member and FFS Member plan rows.

Fax Pigeon

HIPAA-compliant fax with a signed BAA on every plan

Plans start at $4.99 a month, billed annually, for 200 pages, with your own number and unlimited people. Your first fax is free.

Free porting of your local number
Fax from your email
AI summary of every inbound fax
E-signatures
Contact management
Delivery proof

Plans and pricing

Know a practice that still faxes? Refer it through the referral program and earn 20% of its plan, every month it stays.