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PRIOR AUTHORIZATION FORM
Blockade Medicare
Unless otherwise indicated below, authorization quantities are limited to the manufacturer
recommended dosageComplete online at www.selecthealth.org/pa or
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How to fill out sublocade - medicare
How to fill out sublocade - medicare
01
Consult with your healthcare provider to see if Sublocade is the right treatment option for you under Medicare.
02
Ensure you have a prescription for Sublocade from a qualified healthcare provider.
03
Provide your Medicare information to the pharmacy when filling the prescription.
04
Follow the dosing instructions provided by your healthcare provider and pharmacist.
05
Monitor for any side effects and report them to your healthcare provider.
Who needs sublocade - medicare?
01
Individuals with opioid use disorder who are covered by Medicare and are seeking a long-acting treatment option may benefit from Sublocade.
02
Patients who have tried other forms of treatment for opioid addiction without success may also be candidates for Sublocade under Medicare.
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What is sublocade - medicare?
Sublocade-Medicare is a medication-assisted treatment option for individuals with opioid use disorder that is covered by Medicare.
Who is required to file sublocade - medicare?
Healthcare providers who are prescribing Sublocade to Medicare beneficiaries are required to file Sublocade claims with Medicare.
How to fill out sublocade - medicare?
To fill out Sublocade-Medicare claims, healthcare providers need to include specific patient information, dosage details, and treatment dates.
What is the purpose of sublocade - medicare?
The purpose of Sublocade-Medicare is to provide accessible and affordable treatment for opioid use disorder for Medicare beneficiaries.
What information must be reported on sublocade - medicare?
Information such as patient demographics, treatment details, and prescription information must be reported on Sublocade-Medicare claims.
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