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This document is a form for requesting prior authorization of benefits for non-preferred proton pump inhibitors, including patient and physician information, medication details, and approval criteria.

How to fill out hoosier healthwise non-preferred proton

How to fill out Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form

1. Obtain the Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form from the official website or provider office.
2. Fill out the patient's demographic information including name, date of birth, and insurance details.
3. Provide the prescribing physician’s information, including their name, contact number, and NPI number.
4. Indicate the specific non-preferred proton pump inhibitor being requested.
5. Include relevant medical history and reasons for the medication request, ensuring to cite any previous treatments tried.
6. Attach any necessary medical documentation or notes from the physician to support the request.
7. Review the form for completeness and accuracy to prevent delays.
8. Submit the form to the appropriate Hoosier Healthwise address, following any specific submission guidelines provided.

Who needs Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

1. Individuals enrolled in the Hoosier Healthwise program who require coverage for non-preferred proton pump inhibitors.
2. Prescribing physicians who need authorization for a patient’s medication that is not listed as preferred under the plan.

People Also Ask about

Do proton pump inhibitors require a prescription?

PPIs are available both over the counter and by prescription. Brands include Nexium, Prevacid and Prilosec. Taking a proton pump inhibitor alone or with another medicine (like an antibiotic) can help treat conditions involving excess stomach acid.

Why doesn't insurance cover omeprazole?

Some insurers may exclude omeprazole because it's available over the counter. That said, over-the-counter omeprazole only comes in a 20-mg dose, whereas with a prescription, you can get a 10-mg, 20-mg, and a 40-mg dose, depending on your needs.

Are proton pump inhibitors over prescribed?

Yet studies consistently show that proton pump inhibitors are being overprescribed worldwide in both primary and secondary care.3,4,5,6,7,8,9 Between 25% and 70% of patients taking these drugs have no appropriate indication.

Why is lansoprazole not covered by insurance?

Non-Covered Over-the-counter products - Nexium® (esomeprazole) 20mg, Prilosec OTC®, Prevacid® (lansoprazole) 15mg, Omeppi 20mg, Zegerid 20mg capsules or omeprazole/sodium bicarbonate 20mg capsules are not covered because these medications are available without a prescription and therefore excluded from coverage under

Why are proton pump inhibitors not covered by insurance?

it's actually because most PPI's and H2 blockers are considered ``short term therapy''. most insurances will only cover the 90ds/year because anything after that is considered a long term issue and should be dealt with in another manner ie a GI scope to get to the underlying issue.

Is pantoprazole covered by insurance?

Generic pantoprazole is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.

What is the controversy with proton pump inhibitors?

Although PPIs are generally considered safe, researchers have identified potential risks associated with them, especially when using them long-term. PPIs may increase your risk of: A Clostridioides difficile (C. diff) infection. PPIs may change the balance of bacteria in your gut, increasing your risk of an infection.

What is the age limit for recommending nonprescription proton pump inhibitors?

Over-the-counter (OTC) PPIs are FDA approved for treating frequent heartburn in patients 18 years old and older. Frequent heartburn is defined as when a patient experiences symptoms at least two times per week.

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What is Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

The Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form is a document used to request approval for coverage of non-preferred proton pump inhibitors (PPIs) under the Hoosier Healthwise program, which provides healthcare services to eligible individuals in Indiana.

Who is required to file Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

Providers prescribing non-preferred proton pump inhibitors for patients covered under the Hoosier Healthwise program must file the Prior Authorization of Benefits Form on behalf of their patients.

How to fill out Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

To fill out the form, providers should include patient information, details about the prescribed medication, clinical justification for the non-preferred PPI, and any relevant medical history that supports the need for the request.

What is the purpose of Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

The purpose of the form is to ensure that non-preferred proton pump inhibitors are medically necessary for the patient, to comply with insurance guidelines, and to facilitate the approval process for medication coverage.

What information must be reported on Hoosier Healthwise Non-Preferred Proton Pump Inhibitors Prior Authorization of Benefits Form?

The form must include the patient's demographics, insurance details, provider's information, medication specifics, reasons for prescribing the non-preferred PPI, and any previous treatments or medications attempted by the patient.