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Pharmacy Prior Authorization AETNA BETTER HEALTH PENNSYLVANIA & AETNA BETTER HEALTH KIDS Antidepressants Formulary (Medicaid) This fax machine is located in a secure location as required by HIPAA

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What is abh-penn-antidepressants-non-formulary-pa-form accessible pdf?

This document provides information about non-formulary antidepressants that require prior authorization in Pennsylvania.

Who is required to file abh-penn-antidepressants-non-formulary-pa-form accessible pdf?

Healthcare providers and facilities in Pennsylvania are required to file this form for non-formulary antidepressants.

How to fill out abh-penn-antidepressants-non-formulary-pa-form accessible pdf?

The form must be completed with patient information, prescribing provider details, medication details, and the reason why the non-formulary medication is necessary.

What is the purpose of abh-penn-antidepressants-non-formulary-pa-form accessible pdf?

The purpose of this form is to request prior authorization for non-formulary antidepressants in Pennsylvania.

What information must be reported on abh-penn-antidepressants-non-formulary-pa-form accessible pdf?

The form must include patient demographic information, medical history, medication details, and prescribing provider information.

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