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PRIOR AUTHORIZATION REQUEST FORM FOR
SPECIALTY PRESCRIPTION MEDICATIONSTYPE OF SPECIALTY MEDICATION REQUEST. PLEASE SELECT ONE OPTION.**Note: If requesting a selfinjectable, fax completed form to
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What is type of specialty medication?
Specialty medication is a category of drugs that are used to treat complex or rare conditions.
Who is required to file type of specialty medication?
Healthcare providers, pharmacists, and insurance companies are required to file type of specialty medication.
How to fill out type of specialty medication?
Type of specialty medication can be filled out electronically or through paper forms provided by the appropriate regulatory agency.
What is the purpose of type of specialty medication?
The purpose of type of specialty medication is to ensure that patients receive the necessary medications for their unique medical conditions.
What information must be reported on type of specialty medication?
Information such as the patient's name, prescribed medication, dosage, and prescribing physician must be reported on type of specialty medication.
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