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WVCHIP WV Children s Health Insurance Program Pharmacy Prior Approval Program PO Box 9511 HSCN WVU School of Pharmacy Morgantown WV 26505 Phone 1-800-847-3859 FAX 1-800-531-7787 Prior Approval Request Form I. Patient and Medication Information Patient Name Last First MI Requested Medication Name Primary Diagnosis for use of this drug Patient s WVCHIP Identification Patient s Date of Birth Dose Directions Optional Diagnosis Code ICD-9-CM Secondary Diagnoses of Concern II. Prescriber...
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How to fill out pharmacy prior approval program

01
Step 1: Collect all necessary information and documentation such as medical records, prescription details, and patient's insurance information.
02
Step 2: Review the pharmacy prior approval program guidelines and requirements. Make sure you understand the criteria and any specific forms or documentation that needs to be submitted.
03
Step 3: Complete the necessary forms or documentation accurately and completely. Double-check for any missing information or errors.
04
Step 4: Submit the filled-out forms along with any supporting documents through the designated channel specified by the pharmacy prior approval program.
05
Step 5: Follow up on the submission to ensure it has been received and is being processed. If there are any issues or delays, contact the pharmacy prior approval program for assistance.
06
Step 6: Wait for the decision from the pharmacy prior approval program. This can take varying amounts of time, so be patient.
07
Step 7: If the prior approval is granted, proceed with filling the prescription as per the program's instructions. If it is denied, explore alternative options or contact the program for further clarification or appeals process.

Who needs pharmacy prior approval program?

01
Patients who have insurance plans that require prior approval for certain medications or treatments.
02
Pharmacies or healthcare providers who need authorization from insurance plans before dispensing specific drugs or conducting certain procedures.
03
Medical professionals who prescribe medications or treatments that fall under the pharmacy prior approval program's criteria.
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Pharmacy prior approval program is a process where a pharmacy must obtain approval before dispensing certain medications.
Pharmacies are required to file pharmacy prior approval program.
Pharmacy prior approval program can be filled out by submitting the necessary information and documentation to the appropriate authority.
The purpose of pharmacy prior approval program is to ensure proper authorization and control over the dispensing of certain medications.
Information such as patient details, prescriber's information, medication details, and reason for authorization must be reported on pharmacy prior approval program.
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