Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of the document for the current year.

Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi

Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) is a legal document that was released by the Mississippi Division of Medicaid - a government authority operating within Mississippi.

FAQ

Q: What is the Standardized One Page Pharmacy Prior Authorization Form for Praluent (Alirocumab)?A: The Standardized One Page Pharmacy Prior Authorization Form is a form used in Mississippi for requesting prior authorization for Praluent (Alirocumab) from a pharmacy.

Q: What is Praluent (Alirocumab)?A: Praluent (Alirocumab) is a medication used to lower LDL cholesterol levels in patients with certain cardiovascular diseases.

Q: What is prior authorization?A: Prior authorization is a process used by insurance companies to determine if they will cover the cost of a medication or procedure.

Q: Why is a prior authorization needed for Praluent (Alirocumab)?A: A prior authorization is needed for Praluent (Alirocumab) because it is an expensive medication and insurance companies want to ensure that it is only prescribed to patients who meet certain criteria.

Q: Who can submit the Standardized One Page Pharmacy Prior Authorization Form for Praluent (Alirocumab)?A: The Standardized One Page Pharmacy Prior Authorization Form can be submitted by a pharmacist or a prescriber (such as a doctor).

Q: What information do I need to provide on the Standardized One Page Pharmacy Prior Authorization Form?A: You will need to provide information about the patient, the prescriber, the medication (including the diagnosis and other treatments tried), and the reason for the request for Praluent (Alirocumab).

Q: How long does it take to get a response after submitting the Standardized One Page Pharmacy Prior Authorization Form?A: The response time can vary, but it is typically within a few days to a week.

Q: What should I do if my request for prior authorization is denied?A: If your request for prior authorization is denied, you can appeal the decision or talk to your doctor about alternative treatment options.

Q: Is the Standardized One Page Pharmacy Prior Authorization Form the same for all medications?A: No, the Standardized One Page Pharmacy Prior Authorization Form may vary depending on the medication and the state.

ADVERTISEMENT

Form Details:

  • Released on October 26, 2021;
  • The latest edition currently provided by the Mississippi Division of Medicaid;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Division of Medicaid.

Download Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi

4.3 of 5 (29 votes)
  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi

    1

  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 2

    2

  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 3

    3

  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 4

    4

  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 1
  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 2
  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 3
  • Standardized One Page Pharmacy Prior Authorization Form - Praluent (Alirocumab) - Mississippi, Page 4
Prev 1 2 3 4 Next
ADVERTISEMENT