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AUS40840 Page 1 of 2PRESCRIPTION AND SERVICE REQUEST FORMATTED(deutetrabenazine) tabletsPlease fax completed form to 18442576126 For questions, call 18008878100Patient Authorization I authorize each

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To fill out the www.humanacomproviderpharmacy-resources/prior-authorization for pharmacy, follow these steps:

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The www.humana.com/provider/pharmacy-resources/prior-authorization for pharmacy is a process by which a healthcare provider must obtain approval from an insurance company before a patient can receive certain medications.

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