Alabama Medicaid Tobacco Treatment Coverage

Medicaid Covered Services
Physicians can click to download this document containing information and instructions for Medicaid covered services.

Pharmacy Prior Authorization

Physicians can click to download this Pharmacy Prior Authorization Form.

Fax Referral Form: English or Spanish

Download the form by clicking on the appropriate one, and fax it to 1-800-692-9023. The quitline will attempt contact with your patients for enrollment in quitline services. Progress reports are available upon request.

Download: English

Download: Spanish