Search results with tag "Medication request"
Procedures, programs, and drugs that require precertification
member.aetna.comOr, they can fax applicable request forms to 1-877-269-9916. • Yourprovider can use the drug-specific Specialty Medication Request Form located online under “Specialty Pharmacy Precertification.” • Yourprovider can submit Specialty Pharmacy precertification requests electronically using provideronline tools and resources at our provider ...
Procedures, programs and drugs that require precertification
www.aetna.comFor the following services, providers call 1-866-752-7021 for precertification and fax applicable request ... Specialty Medication Request Form located online under ... (daratumumab, J9145) Darzalex Faspro (daratumumab and . care —
PRESCRIPTION DRUG MEDICATION REQUEST …
www.highmarkblueshield.com1. Submit a separate form for each medication. 2. Complete ALL information on the form. NOTE: The prescribing physician (PCP or Specialist) should, in most cases, complete the form. 3. Please provide the physician address …