Get Prior Authorization Request - Acid Prior Authorization Request -

Filling out the Prior Authorization Request for ® or Acid® is a crucial step in obtaining medication coverage. This guide will provide clear, step-by-step instructions to help you successfully complete the form online.

Follow the steps to fill out the form correctly and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s name and identification details including their ID, date of birth, and NPI number. These details are essential for processing the request.
3. Fill in the physician’s name and specialty, followed by their office telephone and fax number. This helps in verifying the prescriber’s credentials.
4. Indicate the specific drug being prescribed by selecting from the options provided: , acid (generic), or other. Additionally, specify the prescribed dose and frequency.
5. Provide the diagnosis by selecting from the provided options, including prostate cancer, bone metastases, multiple myeloma, hypercalcemia, or other. This information is critical for the authorization process.
6. Enter the appropriate ICD code that corresponds to the diagnosis. This code helps in identifying the medical necessity of the prescribed medication.
7. If the diagnosis is prostate cancer, respond to whether the patient has castration-recurrent prostate cancer and attach any required documentation.
8. If applicable, answer the relevant questions regarding the patient’s bone metastases, osteoporosis treatment, and pre-treatment T-scores.
9. Complete the FRAX score questions to provide details about the patient's fracture risk, which may impact the decision regarding authorization.
10. Document the primary cancer if necessary and ensure any required attachments or supporting documentation from the patient's medical records are included.
11. Finally, attest to the accuracy of the information provided by signing and dating the form. After finishing the form, users can save changes, download, print, or share the completed request.

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