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OPTIMA HEALTH PLAN PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST* Directions: The prescribing physician must sign and clearly print name (preprinted stamps not valid) on this request. All other information
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How to fill out drug requested saxenda

01
To fill out a drug request for Saxenda, follow these steps:
02
Obtain the Saxenda drug request form from your healthcare provider or pharmacy.
03
Provide your personal information, including your name, address, and contact details.
04
Fill in your medical history, including any existing conditions, allergies, or medications you are currently taking.
05
Specify the dosage and quantity of Saxenda requested.
06
If required, provide any additional information or documentation, such as previous medical records or test results.
07
Review the completed form for accuracy and completeness.
08
Submit the filled-out form to your healthcare provider or pharmacy for further processing.
09
Follow any additional instructions provided by your healthcare provider or pharmacy regarding the drug request process.

Who needs drug requested saxenda?

01
Saxenda is typically prescribed for individuals who are obese or overweight and have a body mass index (BMI) of 27 or higher with at least one weight-related medical condition, such as high blood pressure, type 2 diabetes, or high cholesterol.
02
It is important to note that the decision to use Saxenda should be made in consultation with a healthcare professional, as they can assess your individual circumstances and determine if the medication is suitable for you.
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Saxenda is a prescription medication used for weight management in adults with obesity or overweight conditions.
Healthcare providers prescribing Saxenda, as well as pharmacies dispensing it, are typically required to file the necessary documentation.
To fill out the request for Saxenda, a healthcare provider must complete a specific form detailing the patient's medical history, treatment goals, and dosage information.
The purpose of requesting Saxenda is to provide a prescription for weight management in patients who meet certain medical criteria.
The request must include patient information, prescribing physician details, medical history, treatment plan, and justification for the need for Saxenda.
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