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PRIOR AUTHORIZATION REQUEST FORM Virginia Premier Quantity Limit Exception Phone: 8007277536Fax back to: 8337707569Certain requests for coverage require review with the prescribing physician. Please
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How to fill out quantity limit prior authorization
How to fill out quantity limit prior authorization
01
Contact your insurance provider to determine if your medication requires a quantity limit prior authorization.
02
Obtain the necessary forms from your insurance provider or download them from their website.
03
Complete the forms with the required information, including your personal details, the medication being prescribed, and the quantity being requested.
04
Provide any supporting documentation requested by your insurance provider, such as a letter from your healthcare provider explaining the medical necessity of the requested quantity.
05
Submit the completed forms and supporting documentation to your insurance provider for review.
06
Wait for a decision from your insurance provider on whether the quantity limit prior authorization has been approved or denied.
Who needs quantity limit prior authorization?
01
Patients who are prescribed medications that have quantity limits set by their insurance provider.
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What is quantity limit prior authorization?
Quantity limit prior authorization is a process where a prescriber must obtain approval from a health insurance company before a certain quantity of a medication can be dispensed.
Who is required to file quantity limit prior authorization?
Prescribers, healthcare providers, or pharmacists are usually required to file quantity limit prior authorization.
How to fill out quantity limit prior authorization?
To fill out quantity limit prior authorization, the prescriber must provide necessary information such as patient details, medical justification, and the requested quantity of medication.
What is the purpose of quantity limit prior authorization?
The purpose of quantity limit prior authorization is to ensure appropriate use of medications, control costs, and prevent misuse or overuse of certain drugs.
What information must be reported on quantity limit prior authorization?
Information such as patient's medical history, diagnosis, previous treatments, and reason for the requested quantity of medication must be reported on quantity limit prior authorization.
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