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Form FA-191 Fintepla (Fenfluramine) Prior Authorization Request Form - Nevada
What Is Form FA-191?
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 the Form FA-191 Fintepla (Fenfluramine) Prior Authorization Request Form?A: The Form FA-191 Fintepla (Fenfluramine) Prior Authorization Request Form is a document used in Nevada to request prior authorization for Fintepla (fenfluramine).
Q: What is Fintepla?A: Fintepla is a medication that contains fenfluramine and is used to treat seizures in patients with Dravet syndrome.
Q: What is fenfluramine?A: Fenfluramine is the active ingredient in Fintepla and works by reducing the frequency of seizures in patients with Dravet syndrome.
Q: Who can use Fintepla?A: Fintepla is specifically approved for use in patients with Dravet syndrome who are 2 years of age and older.
Q: What is prior authorization?A: Prior authorization is a process used by insurance companies to determine if a medication or treatment is medically necessary before providing coverage for it.
Q: Why is the Form FA-191 needed?A: The Form FA-191 is needed to request prior authorization for Fintepla in Nevada, ensuring that the medication is covered by insurance for patients with Dravet syndrome.
Q: What information is required on the Form FA-191?A: The Form FA-191 requires information such as the patient's demographics, diagnosis, previous treatment history, prescriber information, and other relevant details.
Q: How long does it take to get a prior authorization decision?A: The time taken for a prior authorization decision varies, but it usually takes a few days to a couple of weeks.
Q: What happens after the prior authorization is approved?A: If the prior authorization is approved, the insurance company will cover the cost of Fintepla for the patient, subject to any applicable copayments or deductibles.
Form Details:
- Released on July 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-191 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
