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P.O. Box 8738 Dayton, OH 45401-8738 Pharmacy Prior Authorization Request Form PHARMACY FAX # 866-930-0019 Note: Prior Authorization Requests without medical justification or previous medications listed
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What is pharmacy prior authorization request?
Pharmacy prior authorization request is a process used by insurance companies to determine if they will cover a prescribed medication.
Who is required to file pharmacy prior authorization request?
Healthcare providers are usually required to file pharmacy prior authorization requests.
How to fill out pharmacy prior authorization request?
Fill out the form provided by the insurance company with all necessary information regarding the patient and prescribed medication.
What is the purpose of pharmacy prior authorization request?
The purpose of pharmacy prior authorization request is to ensure that prescribed medications are medically necessary and cost-effective.
What information must be reported on pharmacy prior authorization request?
Information such as patient details, prescribing healthcare provider, prescribed medication, diagnosis, and reason for request must be reported on the pharmacy prior authorization request.
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