Patient Enrollment

Electronic Prescription and Prior Authorization

Electronic prescriptions and prior authorizations are easy with ePrescribe and CoverMyMeds.

You and your patient will enjoy the convenience!

  • You save time, staffing and supplies costs.
  • Our pharmacists and clinicians are available to your patients via phone 24/7 and through BriovaLive video consults Monday - Friday.
  • Your patients get free shipping to anywhere in the United States.
  • Electronic prior authorization (ePA) submission is available through CoverMyMeds Opens in a new window.
  • Count on accuracy, safety and service!

Download Enrollment Forms

Condition Fillable PDF
Crohn’s/Ulcerative Colitis Disease Fillable PDF
Cystic Fibrosis Fillable PDF
Dermatology Fillable PDF
Enzyme Replacement Therapy Fillable PDF
General Enrollment Fillable PDF
Growth Hormone Fillable PDF
Hematopoietic Fillable PDF
Hemophilia Fillable PDF
Hepatitis C Fillable PDF
HIV Fillable PDF
Hyperlipidemia Fillable PDF
Immune Globulin Therapy Fillable PDF
Infertility (General)* Please contact Avella for more information at 877-358-9016.
Makena Fillable PDF
Multiple Sclerosis Fillable PDF
Neuromuscular Therapy Fillable PDF
Oncology-Oral/Infusable-Injectable Fillable PDF
Oncology-Revlimid, Pomalyst, Thalomid Fillable PDF
Ophthalmology Fillable PDF
Osteoarthritis Fillable PDF
Osteoporosis Fillable PDF
Pulmonary Arterial Hypertension Fillable PDF
Rheumatology Fillable PDF
RSV Regular Referral Fillable PDF
Sublocade Fillable PDF
Transplant Fillable PDF
Xifaxan Fillable PDF

* Infertility medications are filled at Avella specialty pharmacy, which is an OptumRx subsidiary. Please contact Avella for more information at 877-358-9016.

Optum Specific Forms Fillable PDF
Injectable Psychotropic - Optum Fillable PDF
Neuromuscular - Optum Fillable PDF
RSV - Optum Fillable PDF

ePrescribe and ePA

Send us prescriptions and prior authorizations electronically.

Need Assistance

A member of our team can help answer any questions you have.

Call us at 1-855-4BRIOVA

Email us at