Get the free Provigil (modafinil) Prior Authorization of Benefits (PAB) Form

This document is intended for requesting prior authorization for the medication Provigil (modafinil) and collects necessary patient and physician information along with medical criteria for approval.

How to fill out provigil modafinil prior authorization

How to fill out Provigil (modafinil) Prior Authorization of Benefits (PAB) Form

1. Obtain the Provigil (modafinil) Prior Authorization of Benefits (PAB) Form from your healthcare provider or the insurance company's website.
2. Fill out the patient information section, including the patient's name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including name, contact number, and NPI number.
4. Specify the medication name (Provigil) and dosage prescribed by the physician.
5. Include the medical diagnosis and provide relevant clinical information to justify the need for Provigil.
6. Attach any supporting documentation, such as previous treatment records or lab results.
7. Review the form for accuracy and completeness before submitting.
8. Submit the completed form to the insurance company via the preferred method (fax, email, or online portal).
9. Follow up with the insurance company to confirm receipt and check the status of the authorization.

Who needs Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

1. Patients with conditions such as narcolepsy, obstructive sleep apnea, or shift work sleep disorder who require treatment with Provigil.
2. Individuals whose insurance plan mandates prior authorization for coverage of Provigil.
3. Healthcare providers prescribing Provigil on behalf of patients to ensure medication coverage.

People Also Ask about

Which condition is modafinil Provigil FDA approved to treat?

PROVIGIL is indicated to improve wakefulness in patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and shift work sleep disorder.

What is the difference between modafinil and Provigil?

Modafinil is a medication that treats excessive tiredness caused by certain sleep conditions like narcolepsy, sleep apnea and shift work sleep disorder. The brand name of this medication is Provigil®.

Does modafinil require prior authorization?

Yes, Provigil may require prior authorization before you can begin taking it. You may need prior approval for certain prescription medications, such as those with a generic version or that people take to treat a specific condition.

Does the NHS prescribe modafinil?

If necessary, a GP or specialist may prescribe a type of medicine known as a stimulant, such as modafinil, pitolisant or solriamfetol. These medicines stimulate your central nervous system, which can help keep you awake during the day. They're usually taken as tablets every morning.

What are the benefits of modafinil?

Modafinil is a wakefulness-promoting drug used to treat excessive sleepiness due to narcolepsy, obstructive sleep apnea, or shift work sleep disorder. Sometimes it is used off-label as a cognitive enhancer. Modafinil's exact mechanism is unclear, though it affects many neurotransmitter systems in the brain.

Does modafinil need prior authorization?

All requests for Provigil (modafinil) and Nuvigil () require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below.

What are three drugs that require prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Epidiolex Epidiolex Erythroid Stimulants , , Procrit and Retacrit, Mircera Esbriet Esbriet Evenity Evenity242 more rows

Is a prescription required for modafinil?

This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Tablet.

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What is Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

The Provigil (modafinil) Prior Authorization of Benefits (PAB) Form is a document required by insurance companies to determine the medical necessity of prescribing the medication Provigil.

Who is required to file Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

Healthcare providers, such as physicians or pharmacists, are typically required to file the Provigil (modafinil) Prior Authorization of Benefits (PAB) Form on behalf of patients seeking coverage for the medication.

How to fill out Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

To fill out the Provigil (modafinil) Prior Authorization of Benefits (PAB) Form, the healthcare provider should provide patient information, medication details, diagnosis codes, treatment history, and any other pertinent medical information as required by the insurance provider.

What is the purpose of Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

The purpose of the Provigil (modafinil) Prior Authorization of Benefits (PAB) Form is to ensure that the prescribed medication is medically necessary and to secure insurance coverage before the patient can obtain the medication.

What information must be reported on Provigil (modafinil) Prior Authorization of Benefits (PAB) Form?

The information that must be reported on the Provigil (modafinil) Prior Authorization of Benefits (PAB) Form includes patient demographics, prescribed dosage, duration of treatment, relevant medical history, and justification for why Provigil is needed over other treatment options.