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Member Name (print): ___GEORGIANonFormulary or Step Therapy Prescription Drug Form Kaiser Permanent Health Record Number: ___ DOB:___ Print or Stamp below: Prescriber Name: Prescriber Phone number:
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How to fill out wwwscanhealthplancomscan-resourcespharmacyprior authorization and step

How to fill out wwwscanhealthplancomscan-resourcespharmacyprior authorization and step
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Go to the website www.scanhealthplan.com/scan-resources/pharmacy/prior-authorization.
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Who needs wwwscanhealthplancomscan-resourcespharmacyprior authorization and step?
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Individuals who are members of Scan Health Plan and need to request prior authorization for medication.
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