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Fax completed prior authorization request form to 8552473677 (Integrated population) or 8552467736 (SMI Non-Title population) or submit Electronic Prior Authorization through CoverMyMeds or Subscripts.
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Download the concomitant-antipsychotic-request-form-mcazrbha accessible pdf from the MCAZ website.
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Fill in the required information such as patient details, prescriber information, and reason for requesting concomitant antipsychotic medication.
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Patients who require concomitant antipsychotic medication as prescribed by their healthcare provider.
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Healthcare providers who need to request concomitant antipsychotic medication for their patients.
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The concomitant-antipsychotic-request-form-mcazrbha accessible pdf is a form used to request concomitant use of antipsychotic medications.
Healthcare providers and prescribers are required to file the concomitant-antipsychotic-request-form-mcazrbha accessible pdf.
The form must be filled out with patient information, medication details, and reasoning for the concomitant use of antipsychotic medications.
The purpose of the form is to request approval for the concomitant use of antipsychotic medications in a patient.
Patient information, medication details, and reasoning for the concomitant use of antipsychotic medications must be reported on the form.
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