Prescription Drugs Templates

Individuals who reside in British Colombia may use this form when they would like to apply to enter the Medical Service Plan (MSP).

A prescribing physician or a nurse practitioner from British Colombia can complete and submit the application to allow individuals to become a part of a psychiatric medication plan.

This form is used for applying to the Common Patient Assistance Program for patients with HIV.

This Form is used for obtaining prior authorization for medications at IHS and 638 Tribal Facilities/Pharmacies in Arizona.

This document is used for keeping track and documenting the usage of controlled substances in the state of Alabama.

This document outlines the plan of care for individuals seeking addiction and recovery services in Nevada under the Comprehensive Addiction and Recovery Act (CARA).

This form is used for the Reference Drug Program in British Columbia, Canada specifically for Proton Pump Inhibitors (PPIs). It may be related to coverage and reimbursement information for these medications.

This document provides an annual list of prescription drugs in Iowa. It is updated regularly to keep healthcare providers and residents informed about the medications available in the state.

This document provides instructions for completing the Rhode Island Medicaid Prior Authorization Form. It is used to request approval for specific medical services or treatments before they can be covered by Medicaid in Rhode Island.

This Form is used for enrolling or disenrolling in the Express Scripts Medicare plan in South Carolina.

This document is an application for a Medicare Advantage Prescription Drug (MAPD) plan for residents of Oklahoma. It is used to apply for a healthcare plan that provides both prescription drug coverage and additional benefits beyond what is offered by Original Medicare.

This document discusses the need for reform in pricing of biopharmaceutical drugs both domestically and internationally. It explores the challenges and potential solutions for ensuring affordable access to these medications.

This document discusses the response of the Trump Administration to the Opioids Crisis. It provides information on the actions taken to address the crisis and combat the opioid epidemic in the United States.

This form is used by agencies in Alabama to request naloxone, a medication that can reverse opioid overdoses.

This document is a special authorization request form for low molecular weight heparin medication in Prince Edward Island, Canada.

This Form is used for applying to the Catastrophic Drug Program in Prince Edward Island, Canada. This program provides financial assistance to residents who require high-cost medications.

This document is a checklist outlining the application requirements for becoming a Pharmacy Benefit Manager (PBM) in South Carolina. It contains the necessary information and steps that need to be followed to apply for PBM licensure in the state.

This Form is used for requesting prior authorization or preferred drug list for stimulants and related agents in Wisconsin. It provides instructions on how to fill out the form and submit it to the appropriate authority.

This form is used for recording information about controlled substances in Virginia.

This document is for reporting incidents of drug diversion in Vermont. It provides a way for individuals to report suspicious activities or behaviors related to the illegal use or distribution of drugs.

This type of document is a prescription report used in the state of Virginia. It provides information about medication prescribed to a patient.

This document is a medical prescription form used in Washington, D.C. It is used by healthcare providers to prescribe medications to their patients.

This Form is used for submitting a prior authorization drug attachment for antiemetics and cannabinoids in the state of Wisconsin. It provides instructions on how to complete and submit the form for approval.

This form is used to request expedited emergency supply of prescribed drugs in Wisconsin.

This form is used for filing prescription drug claims in the state of Washington. It allows individuals to seek reimbursement for the cost of prescribed medications.

This Form is used for obtaining a surety bond for prescription drug wholesale distributors in Florida. It is required by the Florida Department of Business and Professional Regulation.

This form is used for obtaining a surety bond for Limited Prescription Drug Veterinary Wholesale Distributors in the state of Florida. The surety bond is required for licensing and to ensure compliance with laws and regulations governing the distribution of prescription drugs for animals.

This form is used for assigning a Certificate of Deposit for Limited Prescription Drug Veterinary Wholesale Distributors in Florida.

This form is used for Medicaid patients in Florida who need prior authorization for colony stimulating factors.

This document is a request for a waiver of reporting requirements for the New Hampshire Prescription Drug Monitoring Program. The waiver is for the purpose of exempting certain individuals or organizations from the obligation to report prescription drug information to the program.