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DEPARTMENT OF HEALTH SERVICES
Division of Medicaid Services
F00081 (07/2021)STATE OF WISCONSIN
Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL)
FOR OPIOID
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How to fill out prior authorizationpreferred drug list
How to fill out prior authorizationpreferred drug list
01
Contact your healthcare provider or pharmacist to obtain the prior authorization form for the preferred drug list.
02
Fill out the form completely and accurately with your personal information, prescription details, and reason for requesting the preferred drug.
03
Submit the form to your insurance provider or pharmacy for review and approval.
04
Wait for confirmation from your insurance provider or pharmacy before obtaining the preferred drug.
Who needs prior authorizationpreferred drug list?
01
Patients who have insurance coverage that requires prior authorization for preferred drugs.
02
Healthcare providers who want to prescribe a preferred drug that requires prior approval.
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What is prior authorizationpreferred drug list?
Prior authorization preferred drug list is a list of medications that require approval from a healthcare provider before they can be dispensed by a pharmacy.
Who is required to file prior authorizationpreferred drug list?
Healthcare providers and pharmacies are required to file prior authorization preferred drug lists.
How to fill out prior authorizationpreferred drug list?
Prior authorization preferred drug lists can be filled out online or by submitting a paper form to the appropriate authority.
What is the purpose of prior authorizationpreferred drug list?
The purpose of prior authorization preferred drug lists is to ensure appropriate and cost-effective use of medications.
What information must be reported on prior authorizationpreferred drug list?
Prior authorization preferred drug lists must include information such as patient name, medication name, dosage, prescriber information, and reason for requesting authorization.
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