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PHARMACY PRIOR AUTHORIZATION INFORMATION Division of Medicaid Pharmacy Prior Authorization Unit 550 High St., Suite 1000, Jackson, MS 39201 Additional Instructions for Completing a Medicaid Pharmacy

How to fill out pharmacy prior authorization information

How to fill out pharmacy prior authorization information:

Gather the necessary information:

1. Gather all relevant medical and prescription information, including the patient's name, date of birth, and insurance information.
2. Obtain the prescription details, such as the drug name, dosage, and quantity.

Review the prior authorization form:

1. Obtain the prior authorization form from the insurance company or healthcare provider.
2. Read the form thoroughly to understand the required information and any specific instructions.

Complete patient and prescriber information:

1. Fill in the patient's personal information, including their name, address, and contact details.
2. Provide the prescriber's information, such as their name, address, and contact information.

Enter the drug details:

1. Include the specific drug name, dosage strength, and quantity required.
2. Indicate the reason for the prescription, whether it is for a new condition or a change in medication.

Provide supporting documentation:

Attach any relevant medical records, lab test results, or other supporting documents that can justify the need for the prescribed medication.

Review and submit the form:

1. Carefully review all the filled-out information for accuracy and completeness.
2. Submit the prior authorization form to the designated recipient, which could be the insurance company, pharmacy, or healthcare provider.

Who needs pharmacy prior authorization information?

Insurance companies:

1. Insurance companies require prior authorization information to assess the medical necessity of certain medications before providing coverage.
2. This helps them evaluate the appropriateness of the prescribed medication based on guidelines and cost-effectiveness.

Healthcare providers:

1. Healthcare providers need prior authorization information to receive approval from insurance companies for prescribing specific medications.
2. This ensures that the prescribed medication aligns with the patient's insurance coverage and minimizes potential financial burdens.

Pharmacies:

1. Pharmacies require prior authorization information to confirm that the prescribed medication has been approved by the insurance company.
2. This avoids issues of denied coverage and allows the pharmacy to proceed with dispensing the medication to the patient.

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