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Office of Medical Assistance Programs FeeforService, Pharmacy Division Phone 18005378862 Fax 18663270191AUSTEDO (deutetrabenazine) (nonpreferred) PRIOR AUTHORIZATION FORM Prior authorization guidelines

How to fill out austedo deutetrabenazine non-preferred prior

How to fill out austedo deutetrabenazine non-preferred prior

1. To fill out the Austedo Deutetrabenazine non-preferred prior, follow these steps: 1. Download the Austedo Deutetrabenazine non-preferred prior form from the official website or request it from your insurance provider.
2. Fill out your personal information, including your name, contact details, and insurance policy number.
3. Provide information about your medical history and any previous treatments you have received for your condition.
4. Include the details of your healthcare provider, such as their name, contact information, and any relevant medical credentials.
5. Describe the clinical reasons for why you believe Austedo Deutetrabenazine is necessary for your treatment and why other alternatives have been ineffective or unsuitable.
6. Attach any supporting documents, such as medical records, test results, or letters from your healthcare provider.
7. Review the completed form to ensure all information is accurate and legible.
8. Submit the filled-out form to your insurance provider as per their instructions, either by mail, fax, or through an online portal.
9. Wait for a response from your insurance provider regarding the approval or denial of your Austedo Deutetrabenazine non-preferred prior request.
10. Follow up with your healthcare provider and insurance provider if necessary to ensure a timely decision and address any further inquiries or requirements.

Who needs austedo deutetrabenazine non-preferred prior?

1. Austedo Deutetrabenazine non-preferred prior is needed by individuals who have been prescribed Austedo Deutetrabenazine to treat their medical condition but face challenges in accessing the medication due to insurance coverage restrictions.
2. These individuals may have tried alternative treatments or other medications without success or may have specific medical conditions or circumstances that make Austedo Deutetrabenazine the most suitable option for their treatment.
3. The determination of who needs Austedo Deutetrabenazine non-preferred prior ultimately depends on the individual's medical condition, treatment history, and their insurance provider's coverage policies.
4. It is advised to consult with a healthcare provider and insurance representative to determine if filing a non-preferred prior request for Austedo Deutetrabenazine is appropriate.

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What is austedo deutetrabenazine non-preferred prior?

Austedo deutetrabenazine non-preferred prior is a process by which a healthcare provider requests approval for the medication Austedo, which contains deutetrabenazine, as a non-preferred option.

Who is required to file austedo deutetrabenazine non-preferred prior?

Healthcare providers who wish to prescribe Austedo as a non-preferred option are required to file the prior authorization.

How to fill out austedo deutetrabenazine non-preferred prior?

To fill out austedo deutetrabenazine non-preferred prior, healthcare providers need to provide detailed information about the patient's medical history, diagnosis, and reasons for choosing Austedo over preferred alternatives.

What is the purpose of austedo deutetrabenazine non-preferred prior?

The purpose of austedo deutetrabenazine non-preferred prior is to ensure that Austedo is prescribed in a safe and appropriate manner and to control costs by encouraging the use of preferred alternatives.

What information must be reported on austedo deutetrabenazine non-preferred prior?

On austedo deutetrabenazine non-preferred prior, healthcare providers must report the patient's diagnosis, previous treatments, any relevant test results, and the reasons for choosing Austedo.