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PA CriteriaInitial Approval: July 26, 2017, CRITERIA FOR PRIOR AUTHORIZATION Tiara (regorafenib)PROVIDER GROUPPharmacyMANUAL Guidelines following drug requires prior authorization: Regorafenib (Tiara)CRITERIA
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What is patient must have one?
Patient must have a valid identification card or account number.
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Healthcare providers or facilities who have treated the patient are required to file patient must have one.
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Patient must have one can be filled out online or submitted through mail with the necessary information.
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The purpose of patient must have one is to ensure accurate record-keeping and identification of patients receiving healthcare services.
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Patient's name, date of birth, address, insurance information, and treatment details must be reported on patient must have one.
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