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ClearPrintPrior Authorization Request
PARIS (canakinumab)
Instructions
Please complete Part A and have your physician complete Part B. Completion and submission is not a guarantee of approval. Any
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How to fill out prior authorization drug list

How to fill out prior authorization drug list
01
Contact your healthcare provider to determine if a prior authorization is needed for your medication.
02
Obtain the necessary prior authorization form from your insurance provider or download it from their website.
03
Fill out the patient information section of the form, including your name, date of birth, address, and insurance information.
04
Provide the details of the medication needing prior authorization, including the name of the medication, dosage, frequency, and reason for prescribing.
05
Have your healthcare provider complete the prescriber information section of the form, including their name, contact information, and reason for prescribing the medication.
06
Submit the completed prior authorization form to your insurance provider either by mail, fax, or online portal.
07
Follow up with your insurance provider to ensure that the prior authorization has been approved before filling your prescription.
Who needs prior authorization drug list?
01
Individuals who have health insurance plans that require prior authorization for certain medications.
02
Patients who are prescribed medications that are not on their insurance plan's formulary.
03
Healthcare providers who prescribe medications that are known to require prior authorization from the patient's insurance provider.
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What is prior authorization drug list?
Prior authorization drug list is a list of medications that require approval from a healthcare provider before insurance will cover the cost.
Who is required to file prior authorization drug list?
Healthcare providers are required to file prior authorization drug list.
How to fill out prior authorization drug list?
Prior authorization drug list can be filled out by including the necessary information for each medication that requires approval.
What is the purpose of prior authorization drug list?
The purpose of prior authorization drug list is to control costs and ensure appropriate use of medications.
What information must be reported on prior authorization drug list?
Information such as patient's name, medication name, dosage, frequency, diagnosis, and healthcare provider's information must be reported on prior authorization drug list.
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