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Washington Preferred Drug Line Prescription Authorization Request

State:
Washington
Control #:
WA-SKU-3825
Format:
PDF
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Description

Preferred Drug Line Prescription Authorization Request The Washington Preferred Drug Line (PDL) Prescription Authorization Request is a form used to request authorization for medications that are not listed on the PDL. This form is used by healthcare providers when a medication that is not on the PDL is clinically necessary for a patient’s care. It is also used to request authorization for medications when the prescribing physician believes that a medication listed on the PDL is not the most clinically appropriate for the patient. The Washington Preferred Drug Line Prescription Authorization Request includes two types of requests: Standard Authorization Requests and Complex Authorization Requests. Standard Authorization Requests are for medications that have Washington State Medicaid reimbursement and are clinically appropriate for the patient’s condition. Complex Authorization Requests are for medications that do not have Washington State Medicaid reimbursement or are not clinically appropriate for the patient’s condition. In order to submit a Washington Preferred Drug Line Prescription Authorization Request, healthcare providers must provide information such as patient information, prescription details, diagnosis code, clinical justification/rationale for the request, and any other relevant information. The PDL team will then review the request and make a determination whether the medication should be authorized or denied.

The Washington Preferred Drug Line (PDL) Prescription Authorization Request is a form used to request authorization for medications that are not listed on the PDL. This form is used by healthcare providers when a medication that is not on the PDL is clinically necessary for a patient’s care. It is also used to request authorization for medications when the prescribing physician believes that a medication listed on the PDL is not the most clinically appropriate for the patient. The Washington Preferred Drug Line Prescription Authorization Request includes two types of requests: Standard Authorization Requests and Complex Authorization Requests. Standard Authorization Requests are for medications that have Washington State Medicaid reimbursement and are clinically appropriate for the patient’s condition. Complex Authorization Requests are for medications that do not have Washington State Medicaid reimbursement or are not clinically appropriate for the patient’s condition. In order to submit a Washington Preferred Drug Line Prescription Authorization Request, healthcare providers must provide information such as patient information, prescription details, diagnosis code, clinical justification/rationale for the request, and any other relevant information. The PDL team will then review the request and make a determination whether the medication should be authorized or denied.

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Washington Preferred Drug Line Prescription Authorization Request