FEP Spinraza Prior Approval Request 2017-2025 free printable template

SPINOZA PRIOR APPROVAL REQUEST Additional information is required to process your claim for prescription drugs. Please complete the cardholder portion, and have the prescribing physician complete

How to fill out fax 1-877-378-4727

How to fill out FEP Spinraza Prior Approval Request

1. Obtain the FEP Spinraza Prior Approval Request form from the official website or your healthcare provider.
2. Fill out the patient information section, including name, date of birth, and insurance details.
3. Provide the diagnosis information, ensuring it aligns with the criteria for Spinraza treatment.
4. Include the prescribing physician’s information, including their contact details and NPI number.
5. Attach all relevant medical records that support the diagnosis and necessity for Spinraza treatment.
6. Clearly indicate the requested dosage and treatment schedule for Spinraza.
7. Review the completed form for accuracy and completeness.
8. Submit the form via the recommended submission method (fax, mail, or online) as instructed.

Who needs FEP Spinraza Prior Approval Request?

1. Patients diagnosed with Spinal Muscular Atrophy (SMA) who are considering or require treatment with Spinraza.
2. Healthcare providers who are prescribing Spinraza for eligible patients.

People Also Ask about

How do I get my prior authorization from CVS Caremark?

The CVS/caremark Prior Authorization number is 1-800-294-5979. Request mail service prescriptions. Request a new prescription with FastStart® Check your order status. Check your drug coverage and cost. Find pharmacies in your network. View your prescription history.

How long does CVS Caremark take to turn around prior authorization?

Receive determinations significantly faster than fax and phone with ePA. Did you know submitting prior authorizations (PAs) by fax or phone can take anywhere from 16 hours to 2 days to receive a determination? CVS Caremark has made submitting PAs easier and more convenient.

How long does prior authorization take with Caremark?

Did you know submitting prior authorizations (PAs) by fax or phone can take anywhere from 16 hours to 2 days to receive a determination? CVS Caremark has made submitting PAs easier and more convenient. Some automated decisions may be communicated in less than 6 seconds!

What is CVS Caremark Physician prior authorization Line?

The CVS/caremark Prior Authorization number is 1-800-294-5979.

What is the fax number for CVS Caremark prior authorization?

PLEASE FAX COMPLETED FORM TO 1-888-836-0730. I further attest that the information provided is accurate and true, and t hat documentation supporting this inf ormation is available for review if requested by CVS Caremark™, the health plan sponsor, or, if applicable, a state or federal regulatory agency.

What is the phone number for CVS prior authorization?

For prior authorization review, your doctor should call CVS Caremark at 1-800-294-5979 before you go to the pharmacy.

What is the number for FEP PA?

Have a question? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time.

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What is FEP Spinraza Prior Approval Request?

FEP Spinraza Prior Approval Request is a formal request that needs to be submitted to obtain authorization for the use of Spinraza, a medication used to treat spinal muscular atrophy, under the Federal Employees Program.

Who is required to file FEP Spinraza Prior Approval Request?

Healthcare providers prescribing Spinraza for their patients enrolled in the Federal Employees Program are required to file the FEP Spinraza Prior Approval Request.

How to fill out FEP Spinraza Prior Approval Request?

To fill out the FEP Spinraza Prior Approval Request, providers need to complete the designated form with patient information, medical history, treatment rationale, and relevant clinical documentation supporting the necessity of the medication.

What is the purpose of FEP Spinraza Prior Approval Request?

The purpose of the FEP Spinraza Prior Approval Request is to ensure that the prescription of Spinraza is medically necessary and appropriate for the patient, following the guidelines set by the Federal Employees Program.

What information must be reported on FEP Spinraza Prior Approval Request?

The information that must be reported on the FEP Spinraza Prior Approval Request includes patient demographics, healthcare provider details, diagnosis, previous treatment history, and supporting clinical evidence that justifies the need for Spinraza.