Fillable express scripts antidepressant snri step therapy form

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Prior Authorization Form Antidepressant SNRI Step Therapy This form is based on Express Scripts standard criteria and may not be applicable to all patients certain plans and situations may require additional information beyond what is specifically requested. Fax completed form to 1-800-357-9577 If this an URGENT request please call 1-800-417-8164 Additional forms available www.
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express scripts antidepressant snri step therapy
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