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This document is a request form for prior approval to process claims for prescription drugs including Imitrex, Sumavel, and Treximet. It requires details from both the cardholder and the prescribing
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How to fill out imitrexsumaveltreximet prior approval request
How to fill out IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST
01
Begin by obtaining the IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST form from your healthcare provider or insurance company.
02
Fill in the patient's personal information including name, date of birth, and insurance details.
03
Specify the medical diagnosis that necessitates the use of IMITREX/SUMAVEL/TREXIMET.
04
Provide details of previous treatments attempted, including medications and therapies used.
05
Include supporting documentation, such as medical history and treatment records, to justify the need for the medication.
06
Complete the physician's section, ensuring that the prescribing doctor's information and signature are present.
07
Review the form for accuracy and completeness before submission.
08
Submit the form to the specified insurance company or health plan, following any specific instructions provided.
Who needs IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
01
Patients diagnosed with migraine disorders who require medication for relief and their healthcare providers who are submitting the request on their behalf.
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People Also Ask about
Why do you need a prescription for sumatriptan?
Sumatriptan has caused serious side effects in some people, especially people who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as the benefits that it can have. This medicine is available only with your doctor's prescription.
Is Treximet the same as ?
Treximet 85/500mg tablet when migraine is moderate or severe in intensity. Other Names: 100mg. Treximet 85/500mg.
Why is sumatriptan restricted?
Sumatriptan is not suitable for some people. To make sure it's safe for you, tell your doctor if you: have ever had an allergic reaction to sumatriptan or any other medicine. have a heart problem such as coronary heart disease, chest pain (angina), heart rhythm problems (arrhythmia) or you've had a heart attack.
Is sumatriptan covered by insurance?
Sumatriptan () is an inexpensive drug used to treat migraines. It is more popular than comparable drugs. It is available in generic and brand versions. Generic sumatriptan is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.
Do you need a prior authorization for sumatriptan?
Why does Sumatriptan require prior authorization? Sumatriptan is classified as a specialty medication due to its cost and specific indications. PA ensures that Sumatriptan is the right choice for the patient, especially if other treatments have not been effective.
Why can you only get 9 sumatriptan a month?
If you take sumatriptan more often or for longer than the recommended period of time, your headaches may get worse or may occur more often. You should not take sumatriptan or any other headache medication for more than 10 days per month.
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What is IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
The IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST is a request that healthcare providers submit to insurance companies to gain authorization for the use of these specific medications, which are used to treat migraine headaches.
Who is required to file IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
Healthcare providers, such as physicians or their office staff, are typically required to file the IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST on behalf of the patient.
How to fill out IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
To fill out the IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST, the healthcare provider must complete a form that includes patient information, the prescribed medication, clinical details, and any relevant medical history that supports the need for the medication.
What is the purpose of IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
The purpose of the IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST is to ensure that patients meet the criteria set by insurance companies for the coverage of these medications, thereby facilitating access to necessary treatments for migraine relief.
What information must be reported on IMITREX/SUMAVEL/TREXIMET PRIOR APPROVAL REQUEST?
The information that must be reported includes patient demographics, the prescribing physician's details, the specific medication requested, the diagnosis, previous treatments tried and tolerated, and any supporting clinical information or documentation.
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