Get Tofacitinib Prior Authorization Form - Cat Health Benefits

This guide provides step-by-step instructions to assist you in completing the Tofacitinib Prior Authorization Form for Cat Health Benefits online. By following these directions, you will ensure that all necessary information is accurately provided, facilitating a smooth submission process.

Follow the steps to efficiently complete the prior authorization form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill out the prescriber information section, including the last name, first name, DEA/NPI number, specialty, phone, and fax details.
3. Provide member information by entering the last name, first name, member ID number, and date of birth.
4. In the medication information section, specify the drug name and strength, as well as the prescribed quantity and dosing regimen.
5. Indicate the diagnosis and the duration of treatment as requested.
6. Respond to all questions under the initial therapy section. Each question requires a yes or no answer. Should the patient meet specific criteria, include necessary documentation with your submission.
7. If applicable, complete the renewal therapy section, again providing yes or no responses where required.
8. Add any comments relevant to the patient's treatment or circumstances at the end of the form.
9. Finish the form process by signing in the designated area, including the date, and indicating the name and title of the authorized medical staff.
10. After completing the form, you can save changes, download, print, or share the document as needed.

Complete your Tofacitinib Prior Authorization Form online today for a smooth approval process.