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Cymbal ta (duloxetine) PRIOR AUTHORIZATION FORM
Coverage Criteria:
Members with:
A. Major depressive disorder and generalized anxiety disorder: Require a documented failure to a formulary SSRI
and
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Members with is a form used to report the members or owners of a particular organization.
Who is required to file members with?
Any organization that has members or owners is required to file members with.
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Members with can be filled out by providing information about each member or owner of the organization.
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The purpose of members with is to maintain transparency and accountability by listing out the individuals who have ownership or membership in an organization.
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Information such as name, contact details, and ownership percentage of each member must be reported on members with.
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