Get Prior Authorization Request - Tobi

Completing the Prior Authorization Request for TOBI online is a critical step in ensuring the necessary medications are covered under the patient's benefit plan. This guide will provide you with clear and straightforward instructions on how to accurately fill out the form.

Follow the steps to successfully fill out the Prior Authorization Request - TOBI online.

1. Press the ‘Get Form’ button to access the Prior Authorization Request - TOBI form and open it for editing.
2. Begin by entering the patient’s name, ID, date of birth, and other identifying information in the corresponding fields.
3. Fill in the physician's name, specialty, office telephone, and fax number to ensure proper communication.
4. Indicate the prescribed medication by selecting either TOBI®, TOBI Podhaler®, Bethkis®, or other as applicable.
5. Provide the diagnosis by selecting from available options such as cystic fibrosis or bronchiectasis and specifying any other diagnosis.
6. Enter the appropriate ICD code relevant to the patient's condition.
7. Indicate whether Pseudomonas aeruginosa is present in the airway cultures and whether there is a history of infection or colonization.
8. Complete the specific sections based on the patient’s diagnosis, starting with Section A for Bronchiectasis.
9. If bronchiectasis is due to cystic fibrosis, confirm by answering the question in Section B and provide information on any diagnostic testing.
10. At the end of the form, attest to the accuracy of the provided information by signing and dating the form as required.
11. Finally, save your changes, download, print, and/or share the completed form as needed.

Complete your Prior Authorization Request online today to ensure timely medication coverage.