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Date PRIOR AUTH CRITERIA Generic lansoprazole PPI (GI/ULCER) M.D. Last Name: Physician Phone: M.D. First Name: Physician Fax: Patient ID# DOB **FAILURE TO COMPLETE THE FORM MAY RESULT IN AN AUTOMATIC
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Generic lansoprazole - ppi is a proton pump inhibitor medication that is used to reduce stomach acid production.
Manufacturers or distributors of generic lansoprazole - ppi are required to file.
The form for generic lansoprazole - ppi can be filled out online or submitted via mail with the required information.
The purpose of generic lansoprazole - ppi is to provide a more affordable alternative to brand-name versions of the medication.
Information such as the manufacturer's details, dosage strength, lot number, and expiration date must be reported on the generic lansoprazole - ppi form.
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