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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMBenzodiazepine with Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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Healthcare professionals and pharmacies are required to file benzodiazepine prescriptions with the appropriate regulatory bodies.
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Benzodiazepine prescriptions should be filled out with the patient's information, the prescriber's information, the type and dosage of the medication, and the date of the prescription.
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The purpose of filing benzodiazepine prescriptions is to monitor the use of these controlled substances and prevent misuse or abuse.
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The information reported on a benzodiazepine prescription includes the patient's name, date of birth, address, prescriber's name, medication name, dosage, quantity, and refills.
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