Get Tymlos Prior Authorization Request Form (page 1 Of 2)

Filling out the Tymlos Prior Authorization Request Form can be a crucial step in obtaining necessary coverage for medications. This guide provides clear and detailed instructions on how to complete this form online efficiently, ensuring that you provide all necessary information for a successful request.

Follow the steps to complete the Tymlos Prior Authorization Request Form.

1. Press the 'Get Form' button to acquire the Tymlos Prior Authorization Request Form and launch it in your preferred document management system.
2. Enter the member information in the required fields, including the member's full name, date of birth, and insurance ID number. Ensure correct spelling and accurate details.
3. Provide the provider information by filling in the provider name, National Provider Identifier (NPI), office phone, fax number, street address, city, state, and zip code.
4. Complete the medication information section by entering the medication name, strength, whether you are requesting the brand, directions for use, and dosage form.
5. Turn to the clinical information section and respond to each question regarding the patient's therapy history, documenting any necessary medical records for review.
6. Select the appropriate diagnosis and ensure to fill in the ICD-10 code, if known. You may also include the bone mineral density (BMD) T-score in this section.
7. If required, include the member's history of fractures, treatment durations, and any failures or intolerances to previous therapies.
8. Conclude by reviewing the document for completeness. Save your changes, and then download, print, or share the completed form as needed.

Complete your Tymlos Prior Authorization Request Form online to expedite your request process.