Get the free ( extended-release) Prior Authorization Request Form
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Optimal has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations. Visit go.covermymeds.com/OptumRx to begin using this
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What is extended-release prior authorization request?
Extended-release prior authorization request is a process where a prescriber must obtain approval from a patient's insurance company before the insurance will cover the cost of a specific extended-release medication.
Who is required to file extended-release prior authorization request?
The prescriber or healthcare provider is required to file the extended-release prior authorization request on behalf of the patient.
How to fill out extended-release prior authorization request?
The prescriber must complete the necessary forms provided by the insurance company, including patient medical history, reasons for prescribing the extended-release medication, and any supporting documentation.
What is the purpose of extended-release prior authorization request?
The purpose of extended-release prior authorization request is to ensure that the prescribed medication is medically necessary and cost-effective before the insurance company approves coverage.
What information must be reported on extended-release prior authorization request?
The extended-release prior authorization request must include patient demographics, medical history, diagnosis, prescribed medication, dosage, frequency, duration of treatment, and any supporting clinical information.
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