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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F00079A (07/2018)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR AND INSTRUCTIONS
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What is prior authorization drug attachment?
Prior authorization drug attachment is a form that must be submitted to the insurance company for approval before a specific medication can be prescribed.
Who is required to file prior authorization drug attachment?
Healthcare providers or pharmacists are typically responsible for filing the prior authorization drug attachment.
How to fill out prior authorization drug attachment?
The form must be completed with all relevant patient and medication information, including medical justification for the prescription.
What is the purpose of prior authorization drug attachment?
The purpose is to ensure that the medication prescribed is necessary and appropriate, helping to control costs and promote the safe and effective use of medications.
What information must be reported on prior authorization drug attachment?
Information such as patient demographics, medical history, prescribed medication, dosage, frequency, and duration of treatment must be included.
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