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OPTIMA HEALTH COMMUNITY CARE
AND
OPTIMA FAMILY CARE
(MEDICAID)
PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST*
Directions: The prescribing physician must sign and clearly print name (preprinted stamps
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How to fill out drug name
How to fill out drug name
01
To fill out a drug name, follow these steps:
02
Start by writing the generic name of the drug.
03
If applicable, write the brand name of the drug in parentheses after the generic name.
04
Include any additional information such as the dosage strength or form of the drug (e.g. tablets, capsules, injection).
05
If there are specific instructions for the drug, such as when to take it or any special precautions, include this information as well.
06
Make sure to write the drug name clearly and legibly to avoid any confusion.
Who needs drug name?
01
Drug name is needed by various individuals and entities including:
02
- Pharmacists who dispense medications and need to accurately identify the right drug for patients.
03
- Healthcare professionals who prescribe medications and need to communicate the correct drug name to patients and other healthcare providers.
04
- Patients who need to keep track of their medications or communicate their drug information to healthcare providers.
05
- Researchers or regulatory bodies who collect and analyze drug data for studies or monitoring purposes.
06
- Insurance companies or healthcare organizations for billing and reimbursement purposes.
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