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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 gocovri extended

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To fill out drug requested gocovri extended, follow these steps:
02
Obtain the prescription from a healthcare provider.
03
Visit a pharmacy that carries gocovri extended.
04
Provide the prescription to the pharmacist.
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The pharmacist will provide you with the medication.
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Read the instructions provided with the medication carefully.
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Take the medication as prescribed by your healthcare provider.
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If you have any questions or concerns, consult your healthcare provider or pharmacist.

Who needs drug requested gocovri extended?

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The drug requested gocovri extended is typically prescribed to individuals who have been diagnosed with Parkinson's disease.
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It is used to treat dyskinesia, which is a side effect of Parkinson's disease medication.
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Your healthcare provider will determine if gocovri extended is appropriate for your specific condition.
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Gocovri is a prescription medication used to treat involuntary movements (dyskinesia) in patients with Parkinson's disease. The term 'drug requested gocovri extended' refers to an extended request process for obtaining coverage or approval for Gocovri.
Typically, healthcare providers, such as physicians or pharmacists, are required to file the drug request for Gocovri extended on behalf of the patient.
To fill out the drug request, the prescriber must provide patient information, specify the diagnosis, indicate the medical necessity of Gocovri, and include supporting documentation such as previous treatment responses.
The purpose of the drug request for Gocovri extended is to ensure that the patient receives appropriate medication coverage and to justify the medical necessity of the drug to the insurer.
The request must include patient demographics, diagnosis, treatment history, justification for the need for Gocovri, and any relevant medical records or prior authorization requests.
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