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Form FA-187 Orilissa (Elagolix) Prior Authorization Request Form - Nevada
What Is Form FA-187?
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-187?
A: Form FA-187 is the Prior Authorization Request Form for Orilissa (Elagolix).
Q: What is Orilissa (Elagolix)?
A: Orilissa (Elagolix) is a medication used in the treatment of certain conditions in women, such as endometriosis.
Q: What is the purpose of Form FA-187?
A: The purpose of Form FA-187 is to request prior authorization for the medication Orilissa (Elagolix).
Q: Who should use Form FA-187?
A: Form FA-187 should be used by healthcare providers who are prescribing Orilissa (Elagolix) for their patients.
Form Details:
- Released on April 6, 2021;
- 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 printable version of Form FA-187 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
