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Washington Lyrica (pregabalin) Prior Authorizatin Request Form

Washington Lyrica (pregabalin) Prior Authorizatin Request Form

Name: Washington Lyrica (pregabalin) Prior Authorizatin Request Form
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.81 (220 reviews)

Category:

Washington Workers Compensation - Official

State:

Washington

Control #:

WA-SKU-3710

Format:

Instant download

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Public form

Description

Lyrica (pregabalin) Prior Authorizatin Request Form Washington Lyrics (pregabalin) Prior Authorization Request Form is a document used by health care providers and pharmacies to obtain authorization from the Washington State Health Care Authority for the prescription of Lyrics (pregabalin) for a patient. The request form can be used for both brand name and generic pregabalin medications. The form includes sections for patient information, prescribing provider information, pharmacy information, medication information, diagnosis, and authorization request. Depending on the situation, there are different types of Washington Lyrics (pregabalin) Prior Authorization Request Forms. These include: Initial Authorization Request Form, Renewal Authorization Request Form, Change of Medication Request Form, and Step Therapy Exception Request Form.

Washington Lyrics (pregabalin) Prior Authorization Request Form is a document used by health care providers and pharmacies to obtain authorization from the Washington State Health Care Authority for the prescription of Lyrics (pregabalin) for a patient. The request form can be used for both brand name and generic pregabalin medications. The form includes sections for patient information, prescribing provider information, pharmacy information, medication information, diagnosis, and authorization request. Depending on the situation, there are different types of Washington Lyrics (pregabalin) Prior Authorization Request Forms. These include: Initial Authorization Request Form, Renewal Authorization Request Form, Change of Medication Request Form, and Step Therapy Exception Request Form.

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FAQ

The main medicines recommended for neuropathic pain include: amitriptyline ? also used for treatment of headaches and depression. duloxetine ? also used for treatment of bladder problems and depression. pregabalin and gabapentin ? also used to treat epilepsy, headaches or anxiety.

However, elderly patients are more likely to have unwanted effects (eg, dizziness, blurred vision, confusion, or clumsiness) and age-related kidney problems, which may require an adjustment in the dose for patients receiving pregabalin.

Pregabalin is in a class of medications called anticonvulsants. It works by decreasing the number of pain signals that are sent out by damaged nerves in the body.

Clinical information specific to the treatment requested that the payer can use to establish medical necessity, such as: Service type requiring authorization. This could include categories like ambulatory, acute, home health, dental, outpatient therapy, or durable medical equipment. Service start date.

Here are 5 groups of drugs to avoid: NSAIDs. (non-steroidal inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin can increase risk of stomach ulcers, blood pressure, heart failure and affect kidneys. Antihistamines.Sleeping aids.Benzodiazepines.Opioids.

However, elderly patients are more likely to have unwanted effects (eg, problems with balance or walking, swelling in the feet or legs) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving gabapentin.

The American Geriatric Society (AGS) recommends against the use of tertiary TCAs (e.g. amitriptyline) for the treatment of pain in older patients (age ?75 years) because of safety risks including cardiovascular effects, orthostatic hypotension, and cognitive impairment 32.

The following information is generally required for all prior authorization letters. The demographic information of the patient (name, date of birth, insurance ID number and more) Provider information (both referring and servicing provider)Requested service/procedure along with specific CPT/HCPCS codes.

More info

Submit request via: Fax - 1-855-476-4158. Prior Authorization Request Form for pregabalin (Lyrica), pregabalin extendedrelease (Lyrica CR).CONTAINS CONFIDENTIAL PATIENT INFORMATION. The form must be filled out completely, if there is any missing information the Prior. Authorization request cannot be processed. Prior Authorization Request Form for pregabalin (Lyrica), pregabalin extended-release (Lyrica CR). Step. 1. Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826. Lyrica Oral Solution (pregabalin). Prior Authorization Request Form.

Washington Lyrica (pregabalin) Prior Authorizatin Request Form

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What is the best medication for nerve pain in the elderly?

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What information do you need to gather to complete the prior authorization form?

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