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08/11/2014 Prior Authorization Form AETNA BETTER HEALTH OF NEW JERSEY (MEDICAID) Topical Hyaluronic Acid Derivatives (NJ88) This fax machine is located in a secure location as required by HIPAA regulations.
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What is drug name select from?
Drug name select from is the name of the drug that is chosen or selected from a list of available options.
Who is required to file drug name select from?
The manufacturer or distributor of the drug is required to file drug name select from.
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To fill out drug name select from, the manufacturer or distributor must select the appropriate drug name from the provided list or enter the name manually.
What is the purpose of drug name select from?
The purpose of drug name select from is to accurately identify the drug being manufactured or distributed.
What information must be reported on drug name select from?
The drug name, dosage form, and strength must be reported on drug name select from.
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