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General Drug Prior Authorization Form. WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA This is not an all-inclusive list of available covered drugs and includes only managed categories.
Rational Drug Therapy Program WVU School of Pharmacy PO Box 9511 HSCN Morgantown, WV 26506 Fax: 1-800-531-7787 %PDF-1.7
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PDF download: therapeutic drug class – DHHR.
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The Virginia Medicaid prior authorization form is a document that a medical office submits to Provider Synergies, which handles prior authorization requests on behalf of the Department of Medical Assistance Services.The function of this form is to request for Medicaid coverage to be granted to cover a drug which does not appear on the Preferred Drug List (PDL).
The goal of the West Virginia Medicaid program is to make sure medications prescribed by registered providers are appropriate for the patient to whom the medication is being prescribed. Refer to cover page for complete list of rules governing this PDL. To jump to the first Ribbon tab use Ctrl+[. Jan 1, 2018 … WEST VIRGINIA MEDICAID.
West Virginia Medicaid Drug Formulary 2019. There is an established preferred drug list (PDL) which physicians must refer to when prescribing medication to their patients.
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To skip between groups, use Ctrl+LEFT or Ctrl+RIGHT. West Virginia Medicaid contracts with the West Virginia University School of Pharmacy Rational Drug Therapy Program (RDTP) for prior authorization services. This is not an all-inclusive list of available … West Virginia Medicaid Provider Newsletter Molina Medicaid … WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA 10/01/2017 This is not an all-inclusive list of available covered drugs and includes only managed categories. �\
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If they believe it is medically necessary to prescribe a non-preferred drug to their patient, the doctor must fill out a Our support agents are standing by to assist you. C�P�a�X�p�"���r�.��8��H wv medicaid prior authorization form today’s date _____ fax 1-844-633-8428 lab/imaging/radiology registration on c3 is required to submit prior authorization requests whether by fax or electronically. endstream
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Please be aware that our agents are not licensed attorneys and cannot address legal questions. 148 0 obj
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PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA. As of 8/15/2020, Fee-for-Service and Medicaid managed care health plans will: 1) Suspend all drug co-payments for Medicaid, FAMIS and FAMIS Moms members, 2) Cover a maximum of a 90-day supply for all drugs excluding Schedule II drugs. Prior authorization requests can be made by printing, completing and faxing the appropriate PA form to (800) 531-7787. endstream
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There is an established preferred drug list (PDL) which physicians must refer to when prescribing medication to their patients. Refer to cover page for complete list of rules governing this PDL.