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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F11078A (07/2022)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR PROTON

How to fill out prior authorizationpreferred drug list

How to fill out prior authorizationpreferred drug list

1. Obtain the prior authorization form from the insurance company or download it from their website.
2. Review the preferred drug list to ensure that the medication you are requesting is included.
3. Fill out the patient information section accurately, including name, date of birth, and insurance information.
4. Provide detailed information about the medication being requested, including dosage, frequency, and duration of treatment.
5. Attach any supporting documents, such as medical records or a letter of medical necessity from the prescribing physician.
6. Submit the completed form and supporting documents to the insurance company via fax, mail, or online portal.
7. Follow up with the insurance company to ensure that your request is processed in a timely manner.

Who needs prior authorizationpreferred drug list?

1. Patients who wish to have their medication covered by insurance but are prescribed a medication that is not on the preferred drug list.
2. Healthcare providers who need to request coverage for a medication that is not on the preferred drug list for their patient.

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What is prior authorization preferred drug list?

A prior authorization preferred drug list is a list of medications that require approval from a health insurance company before they can be prescribed or covered under a patient's insurance plan.

Who is required to file prior authorization preferred drug list?

Healthcare providers, including doctors and pharmacists, are typically required to file prior authorization requests for medications that are not included in a patient's insurance plan or for those that require additional documentation.

How to fill out prior authorization preferred drug list?

To fill out a prior authorization preferred drug list, providers must complete a prior authorization form detailing the patient's medical history, the medication requested, and the reasons for the request, along with any supporting documentation.

What is the purpose of prior authorization preferred drug list?

The purpose of a prior authorization preferred drug list is to manage medication costs, ensure that prescribed drugs are medically necessary, and promote the use of more cost-effective therapies.

What information must be reported on prior authorization preferred drug list?

The information required typically includes the patient's insurance details, medication information, the prescribing doctor's information, clinical reasons for the drug request, and any previous treatments or responses to similar medications.