All of your patient’s records, including Mediated, are kept separate from the prescription benefits' information from your plan sponsor. This policy is a standard for the industry by which Mediated and other prescription benefit management systems are conducted. Pharmacy Prescriber Mediated Information Pharmacy Prescriber Information is required when your patient is prescribed or receives any Mediated medications during the calendar year. This information must be updated during the calendar year and is used for the purpose of billing. Prescriber Phone Number The pharmacy prescriber telephone number for the pharmacy you administer will be used as the pharmacy call-back phone number for your prescriber/physician information. Prescriber Email Address The pharmacy prescriber email address for the pharmacy you administer will be used for your prescriber/physician information. Prescriber Phone Area Code The pharmacy prescriber area code is used to determine billing. Pharmacist Phone Number The pharmacy prescriber telephone number for the pharmacy you administer will be used as the pharmacy call-back phone number for your prescriber/physician information. Pharmacist Email Address The pharmacy prescriber email address for the pharmacy you administer will be used for your prescriber/physician information. Pharmacist Phone Area Code The pharmacy prescriber area code is used to determine billing.
Q&A
If I am receiving the same Mediated medications I've already prescribed and have no new prescriptions, do I have to include that information in my Prescriber Information? Yes.
I am a pharmacy benefit manager prescribing my patient (or other CPE patient), how do I access the Prescriber Information? This information will be displayed on Mediated's Prescriber Information page. If you are requesting a new Prescriber Information, please fill out the Application Request Form (for the Mediated Prescriber Information Form). Pharmacy Provider Prescriber Information Pharmacy Provider Information is required when your patient is prescribed or receives any Mediated medications during the calendar year. This information must be updated during the calendar year and is used for the purpose of billing. This information is not provided to Division Medical in any way, the information is not used for billing. Prescriber Telephone Number The pharmacy prescriber telephone number for the pharmacy you administer will be used as the pharmacy call-back phone number for your prescriber/physician information.
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Drug Coverage Review Request RSV Therapy SUPPLY ALL PRESCRIBER AND PATIENT INFORMATION Physician Prescriber MD First Name Cardholder ID # Patient Last Name Patient First Name Date of Birth Address
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