Form FA-174 Wakix (Pitolisant) Medications Prior Authorization Request Form - Nevada

What Is Form FA-174?

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-174?A: Form FA-174 is a Medications Prior Authorization Request Form.

Q: What is Wakix (Pitolisant)?A: Wakix (Pitolisant) is a medication.

Q: What is the purpose of the Form FA-174?A: The purpose of the Form FA-174 is to request prior authorization for Wakix (Pitolisant) medication.

Q: Who needs to fill out Form FA-174?A: The form needs to be filled out by individuals who need to request prior authorization for Wakix (Pitolisant) medication.

Q: Is Form FA-174 specific to Nevada?A: Yes, Form FA-174 is specific to Nevada.

Q: Are there any instructions for filling out Form FA-174?A: Yes, instructions for filling out the form are typically provided along with the form.

Q: What other information may be required for the prior authorization request?A: Other information that may be required includes medical records, diagnosis, and supporting documentation.

Q: Who should I contact if I have questions about Form FA-174?A: You should contact the relevant healthcare provider or insurance company for assistance with Form FA-174.

Q: Are there any fees associated with submitting Form FA-174?A: Fees may vary depending on the healthcare provider or insurance company, and it is best to check with them directly.