Instructions for Form F-11078 Prior Authorization / Preferred Drug List (Pa / Pdl) for Proton Pump Inhibitor (Ppi) Capsules and Tablets - Wisconsin

This document contains official instructions for Form F-11078 , Prior Authorization/Preferred Proton Pump Inhibitor (Ppi) Capsules and Tablets - a form released and collected by the Wisconsin Department of Health Services.

FAQ

Q: What is Form F-11078?
A: Form F-11078 is a prior authorization form for proton pump inhibitor (PPI) capsules and tablets.

Q: What is a prior authorization?
A: A prior authorization is a process where healthcare providers must get approval from the insurance company before certain medications are covered.

Q: What are proton pump inhibitors (PPIs)?
A: Proton pump inhibitors (PPIs) are a type of medication used to reduce stomach acid production and treat conditions like acid reflux and ulcers.

Q: Why do I need to fill out this form?
A: You need to fill out this form to request prior authorization or to access the preferred drug list (PDL) for PPI capsules and tablets in Wisconsin.

Q: What is the preferred drug list (PDL)?
A: The preferred drug list (PDL) is a list of medications that are approved and recommended by the insurance company.

Q: How do I fill out Form F-11078?
A: You need to provide your personal information, healthcare provider details, medication information, and the reason why you need the medication.

Q: What happens after I submit Form F-11078?
A: After you submit the form, the insurance company will review the information and determine if the medication is covered or if a prior authorization is needed.

Q: How long does the prior authorization process take?
A: The prior authorization process can take several days to a couple of weeks, depending on the insurance company and the complexity of the request.

Q: Can I appeal a prior authorization denial?
A: Yes, you have the right to appeal a prior authorization denial. You can contact your insurance company for more information on the appeals process.