Get / / Prior Authorization Form - Pharmacy - Amerihealth Caritas

Filling out the Prior Authorization Form for Pharmacy at AmeriHealth Caritas is an essential step in ensuring that your medication needs are met. This guide provides clear and supportive instructions on how to accurately complete the form online, ensuring all necessary information is provided for prompt processing.

Follow the steps to properly complete the form.

1. Press the ‘Get Form’ button to access the Prior Authorization Form and open it within the editing interface.
2. Begin by entering the patient's information in the designated fields, including the patient's name, date of birth, and identification number, ensuring accuracy to prevent processing delays.
3. Next, fill in the physician's details, including their name, phone number, specialty, fax number, and address. Ensure this information is correct as it will be used for communication regarding the authorization request.
4. Select the drug requested from the options provided, including /Naloxone SL tablets. If requesting a non-preferred agent, briefly explain the medical reason for the request.
5. Indicate the anticipated length of therapy in days or months, noting the maximum duration allowed for initial and renewal requests.
6. Complete the diagnosis section by indicating whether this is an initial or renewal request and by checking off the applicable criteria that support the authorization. Ensure to provide explanations for any unchecked criteria on the additional page as needed.
7. In the rationale section, if the criteria are not met, provide additional information that may support the request, including details on the patient's treatment history and ongoing care.
8. Finally, have the physician sign and date the form, confirming that all provided information is accurate and that consent for sharing treatment information with relevant providers is documented.
9. Review the completed document for any errors or omissions. Once finalized, you can save any changes made, download the document, or share it with the appropriate recipient as instructed.

Complete your Prior Authorization Form online today to expedite your medication needs!