Get Hormonal Therapy - Prior Auth

Completing the Hormonal Therapy - Prior Auth form accurately is essential for receiving the necessary approval for medications. This guide will assist you in navigating each section and field of the form to ensure a complete and correct submission.

Follow the steps to complete the Hormonal Therapy - Prior Auth form effectively.

1. Click ‘Get Form’ button to obtain the Hormonal Therapy - Prior Auth form and open it for filling out.
2. Begin by entering the member's name and date of birth as prompted. Ensure you provide accurate patient identifiers.
3. Input the prior authorization number. This should be entered wherever it asks for the PA number.
4. Fill in the patient's ID and physician's information, including their name, specialty, office telephone, NPI number, and fax number.
5. For Section 1, choose the prescribed drug and strength from the provided options. Be sure to select 'Other' if the drug is not listed and specify the name.
6. In Section 2, specify the reason for prescribing , selecting the appropriate condition from the list.
7. Complete the ICD9 code section to indicate the diagnosis related to the therapy.
8. Respond to questions regarding the patient's gender and any relevant health conditions, such as abnormal bleeding and pregnancy status.
9. Continuing through the form, answer questions regarding therapies, prior treatments, and relevant medical evaluations required for the patient's diagnosis.
10. Review all sections carefully for accuracy. Any incomplete or incorrect information may delay the prior authorization process.
11. Finally, ensure that the prescriber or authorized individual signs the form. Include the date to verify timely submission.
12. Once completed, submit the form to the Case Review Unit at CVS Caremark via fax at 1-866-249-6155. Users may also save, download, or print the completed form for their records.

Start completing the Hormonal Therapy - Prior Auth form online today to ensure timely medication approval.