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Fax completed prior authorization request form to 8008547614 or submit Electronic Prior Authorization through CoverMyMeds or Subscripts. All requested data must be provided. Incomplete forms or forms
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It is a form for requesting concomitant use of antipsychotic medications in accessible pdf format.
Healthcare providers prescribing antipsychotic medications are required to fill out this form.
The form should be completed with accurate patient information and details on concomitant antipsychotic medication use.
The purpose of this form is to ensure safe and appropriate concomitant use of antipsychotic medications.
Information such as patient details, current antipsychotic medications, reason for concomitant use, and healthcare provider's details must be reported on the form.
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