Drug prior authorization

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PRESCRIPTION D PRIOR AUTHORIZATION …

www.care1st.com

Page 2 of 2 New 08/13 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Patient Name: ID#: Instructions: Please fill out all applicable sections on both pages completely and legibly.Attach any additional documentation that is important for the review, e.g. chart notes or lab data, to support the prior authorization request.

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C PRESCRIPTION DRUG PRIOR AUTHORIZATION …

www.aetna.com

Form 61-211 (Revised 12-2016) Effective 7/1/2017 Page 3 of 10 GR-69025-CA (5-17) Aetna complies with applicable Federal civil rights …

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251 Drug Management and Prior Authorization

www.bluecrossma.com

Pharmacy Medical Policy Drug Management & Prior Authorization Table of Contents Policy: Commercial Information Pertaining to All Policies Endnotes

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Prior Authorization Program - Broward County, …

www.broward.org

Prior Authorization Program Catamaran®, your pharmacy benefit manager, is committed to maximizing the value of your prescription drug benefit and lowering prescription costs. Prior Authorization (PA) is a clinical program designed to …

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Prior Authorization Program Information - Florida …

www.bcbsfl.com

* Important information on page 1 Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association Prior Authorization Program Information

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