Form FA-79 Prior Authorization Request - Orencia (Abatacept) - Nevada

Form FA-79 Prior Authorization Request - Orencia (Abatacept) - Nevada

What Is Form FA-79?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-79?
A: Form FA-79 is a prior authorization request form.

Q: What is Orencia (Abatacept)?
A: Orencia (Abatacept) is a medication used for the treatment of certain autoimmune diseases, such as rheumatoid arthritis.

Q: Why is prior authorization required for Orencia?
A: Prior authorization is required for Orencia to ensure appropriate use and coverage of the medication.

Q: Who can use Form FA-79?
A: Form FA-79 can be used by healthcare providers in Nevada who wish to request prior authorization for Orencia.

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Form Details:

  • Released on July 28, 2017;
  • The latest edition provided by the Nevada Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FA-79 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

Download Form FA-79 Prior Authorization Request - Orencia (Abatacept) - Nevada

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  • Form FA-79 Prior Authorization Request - Orencia (Abatacept) - Nevada, Page 1
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