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OBESITY TREATMENT AGENTS PRIOR AUTHORIZATION FORM (form effective 1/9/2023)Fax to Perform Rx at 18664971387, or to speak to a representative call 18005886767. SMPR IOR AUTHORIZATION REQUEST INFORMATION

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Individuals who are diagnosed with obesity by a healthcare provider.

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Obesity treatment agents prior are medications or treatments used for managing and treating obesity.

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Healthcare providers and facilities are required to file obesity treatment agents prior.

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