Instructions for Form F-11305 Prior Authorization / Preferred Drug List (Pa / Pdl) for Cytokine and Cell Adhesion Molecule (Cam) Antagonist Drugs for Crohn's Disease - Wisconsin

This document contains official instructions for Form F-11305 , Prior Authorization/Preferred Cell Adhesion Molecule (Cam) Antagonist Drugs for Crohn's Disease - a form released and collected by the Wisconsin Department of Health Services.

FAQ

Q: What is Form F-11305?A: Form F-11305 is the Prior Authorization/Preferred Drug List (Pa/Pdl) for Cytokine and Cell Adhesion Molecule (Cam) Antagonist Drugs for Crohn's Disease in Wisconsin.

Q: What is the purpose of Form F-11305?A: The purpose of Form F-11305 is to request prior authorization for certain drugs used to treat Crohn's Disease in Wisconsin.

Q: What are cytokine and cell adhesion molecule (CAM) antagonist drugs?A: Cytokine and cell adhesion molecule (CAM) antagonist drugs are medications that target specific molecules involved in the immune system's response and can help manage Crohn's Disease.

Q: Who needs to fill out Form F-11305?A: Healthcare providers or their authorized representatives can fill out Form F-11305 to request prior authorization for cytokine and CAM antagonist drugs for their patients with Crohn's Disease.

Q: What information is required on Form F-11305?A: Form F-11305 requires information such as patient demographics, diagnosis, drug information, supporting clinical documentation, and any previous treatment history.

Q: What happens after Form F-11305 is submitted?A: After submission, the form will be reviewed by the appropriate pharmacy benefit manager to determine if prior authorization is granted.

Q: What if prior authorization is denied?A: If prior authorization is denied, the healthcare provider can appeal the decision or explore alternative medication options.