Get the free Non-Formulary Medication-Assisted Treatment Authorization Request Form. addictions t...

Multnomah Other Formulary MAT Prior Authorization Request Form This form is for behavioral health providers (not PCP's) to request approval of formulary medication assisted treatment (MAT) for members

How to fill out non-formulary medication-assisted treatment authorization

How to fill out non-formulary medication-assisted treatment authorization

1. Gather all necessary information such as patient's details, prescriber information, medication information, and reason for non-formulary request.
2. Check with the insurance provider or pharmacy benefit manager for specific requirements and authorization forms.
3. Complete the authorization form accurately and include all required documentation.
4. Submit the form along with any supporting documents to the appropriate department or contact person for review.
5. Follow up with the insurance provider or pharmacy benefit manager to track the status of the authorization request.

Who needs non-formulary medication-assisted treatment authorization?

1. Patients who require medication-assisted treatment with a medication that is not listed on the formulary of their insurance provider or pharmacy benefit manager.

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What is non-formulary medication-assisted treatment authorization?

Non-formulary medication-assisted treatment authorization is the process of obtaining approval for the use of medications that may not be listed on the formulary for treating substance use disorders.

Who is required to file non-formulary medication-assisted treatment authorization?

Healthcare providers who wish to prescribe non-formulary medications for medication-assisted treatment are required to file the authorization.

How to fill out non-formulary medication-assisted treatment authorization?

The authorization form can typically be filled out online or submitted via mail with the necessary information and documentation.

What is the purpose of non-formulary medication-assisted treatment authorization?

The purpose of the authorization is to ensure that the use of non-formulary medications for medication-assisted treatment is appropriate and meets certain criteria.

What information must be reported on non-formulary medication-assisted treatment authorization?

The authorization typically requires information such as patient demographics, medical history, treatment plan, and rationale for using non-formulary medications.