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Office of Medical Assistance Programs FeeforService, Pharmacy Division Phone 18005378862 Fax 18663270191PROBUPHINE (implant) PRIOR AUTHORIZATION FORM Prior authorization guidelines for Opioid Dependence
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What is probuphine implant prior authorization?
Probuphine implant prior authorization is the process by which a healthcare provider must obtain approval from a patient's insurance company before prescribing the Probuphine implant for treating opioid dependence.
Who is required to file probuphine implant prior authorization?
Healthcare providers, such as doctors or clinics prescribing the Probuphine implant, are typically required to file for prior authorization to ensure that the treatment is eligible for coverage under the patient's insurance plan.
How to fill out probuphine implant prior authorization?
To fill out the probuphine implant prior authorization, providers need to complete a specific prior authorization form provided by the insurance company, including patient details, treatment history, and medical justification for the use of the implant.
What is the purpose of probuphine implant prior authorization?
The purpose of probuphine implant prior authorization is to ensure that the treatment is medically necessary, appropriate, and covered under the patient's insurance policy before the actual administration of the implant.
What information must be reported on probuphine implant prior authorization?
Information that must be reported includes the patient's medical history, current medications, previous treatments for opioid dependence, detailed rationale for using the Probuphine implant, and any relevant laboratory or clinical notes.
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