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State of Oklahoma Stoneware Scemblix (Asciminib) Prior Authorization Form Member Name:___ Date of Birth:___ Member ID#:___Drug Information Pharmacy Billing (NDC:___) Start Date (or date of next dose):___
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01
To fill out the state of Oklahoma Soonercare, follow these steps:
02
Visit the Oklahoma Health Care Authority website.
03
Click on the 'Applications' tab.
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Select the 'Medical Assistance' option.
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Download the 'Application for Assistance' form.
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Fill out the form with accurate and detailed information.
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Attach any necessary supporting documents, such as proof of income and residency.
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Sign and date the completed application.
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Submit the application either online, by mail, or in person to the local Oklahoma Department of Human Services (DHS) office.
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If approved, you will receive a notification and further instructions on how to proceed with your State of Oklahoma Soonercare benefits.

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State of Oklahoma Soonercare is designed for individuals and families who meet certain income and eligibility requirements. It provides affordable or free health care coverage to low-income adults, pregnant women, children, seniors, and individuals with disabilities in Oklahoma.
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Those who do not have access to employer-sponsored health insurance or cannot afford private insurance may qualify for State of Oklahoma Soonercare.
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It is particularly beneficial for individuals and families with limited resources who need assistance with medical expenses, including doctor visits, prescriptions, hospitalizations, and preventive care.
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Oklahoma SoonerCare is the state's Medicaid program providing health coverage to eligible individuals and families based on income and other criteria.
Individuals and families in Oklahoma who meet specific income and eligibility criteria are required to file for SoonerCare to receive health coverage.
To fill out the SoonerCare application, individuals can apply online through the Oklahoma Human Services website, by mail using a paper form, or in person at designated offices.
The purpose of Oklahoma SoonerCare is to provide affordable healthcare access to low-income individuals and families, ensuring they receive necessary medical services.
Applicants must report personal information such as name, address, income, family size, and medical expenses when applying for SoonerCare.
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