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HEALTH PARTNERS PLANS 2024 PRIOR AUTHORIZATION REQUEST FORMMultiple Sclerosis Agents Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient.

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How to fill out drug list formulary

01

Gather all necessary information about the medication being prescribed.

02

Fill out the form with the drug name, dosage, frequency, and duration of treatment.

03

Include any special instructions or precautions.

04

Make sure to list any allergies or other medications the patient may be taking.

05

Double check the form for accuracy before submitting it.

Who needs drug list formulary?

01

Healthcare professionals such as doctors, nurses, and pharmacists who are prescribing or dispensing medications.

02

Patients who need to keep track of their medications and communicate them to healthcare providers.

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What is drug list formulary?

Drug list formulary is a list of medications that are approved by a health insurance plan for coverage.

Who is required to file drug list formulary?

Health insurance plans are required to file a drug list formulary.

How to fill out drug list formulary?

To fill out a drug list formulary, health insurance plans must list the medications they cover and any restrictions or limitations.

What is the purpose of drug list formulary?

The purpose of a drug list formulary is to provide transparency to members about which medications are covered by their insurance plan.

What information must be reported on drug list formulary?

The drug list formulary must include the name of the medication, dosage, any restrictions, and cost information.

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