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Form F-11097 Prior Authorization / Preferred Drug List (Pa / Pdl) for Stimulants and Related Agents - Wisconsin
What Is Form F-11097?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-11097?
A: Form F-11097 is a Prior Authorization/Preferred Drug List (Pa/Pdl) for Stimulants and Related Agents in Wisconsin.
Q: What is Prior Authorization?
A: Prior Authorization is a process where a healthcare professional needs to get approval from an insurance company before certain medications are covered.
Q: What is a Preferred Drug List?
A: A Preferred Drug List is a list of medications that are preferred by an insurance company and may have lower out-of-pocket costs for the patient.
Q: What are Stimulants and Related Agents?
A: Stimulants and Related Agents are a type of medication used to treat conditions such as attention deficit hyperactivity disorder (ADHD) and narcolepsy.
Q: Why do I need to fill out Form F-11097?
A: You may need to fill out Form F-11097 if you are prescribed a stimulant or related agent and want it to be covered by your insurance.
Q: How do I fill out Form F-11097?
A: You will need to provide information about yourself, your healthcare professional, and the medication you are requesting.
Q: How long does it take to get approval with Prior Authorization?
A: The timeframe for approval with Prior Authorization can vary, but it is typically within a few days.
Q: What happens if my medication is not on the Preferred Drug List?
A: If your medication is not on the Preferred Drug List, you may need to go through the Prior Authorization process or consider alternative medications that are on the list.
Q: Can I appeal if my Prior Authorization is denied?
A: Yes, you can appeal the denial of a Prior Authorization by providing additional information or requesting a review of the decision.
Form Details:
- Released on September 1, 2019;
- The latest edition provided by the Wisconsin Department of Health 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 fillable version of Form F-11097 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-11097 Prior Authorization / Preferred Drug List (Pa / Pdl) for Stimulants and Related Agents - Wisconsin
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