For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;- Familial Amyloid Polyneuropathy (FAP):
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Cardiologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Diagnosis Types: hATTR Amyloidosis with Polyneuropathy
Concomitant Therapy Restrictions: 1 of Oligonucleotide agents (e.g., inotersen);Patisiran (Onpattro)
Required Documentation: 4 of Biopsy results;Documentation of a pathogenic ttR mutation;Documentation of amyloid deposits;Medical Records
Specialist required details: Specialist Consultation
- Step Therapy: ADHD:
ST Multiple Generics
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE
For details on morphine equivalent dose criteria click HERE;
|