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Office of Medical Assistance Programs FeeforService, Pharmacy Division Phone 18005378862 Fax 18663270191ENBREL () nonpreferred PRIOR AUTHORIZATION FORM (Form effective 1/28/19) Cytokine and CAM Antagonists
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What is non-preferred?
Non-preferred refers to a status or classification given to certain items or services that are considered less desirable or not the first choice.
Who is required to file non-preferred?
Entities or individuals who provide items or services that fall under the non-preferred category may be required to file non-preferred.
How to fill out non-preferred?
To fill out a non-preferred form, you need to provide the necessary information about the item or service being classified as non-preferred.
What is the purpose of non-preferred?
The purpose of non-preferred is to categorize certain items or services as less desirable or not the first choice, based on specific criteria.
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Information about the item or service, reasons for classification as non-preferred, and any supporting documentation may need to be reported on a non-preferred form.
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