Instructions for Form F-11075 Prior Authorization / Preferred Drug List (Pa / Pdl) Exemption Request - Wisconsin

Form F-11075 Prior Authorization/Preferred Drug List (Pa/Pdl) Exemption Request - Wisconsin

This document contains official instructions for Form F-11075 , Prior Authorization/Preferred Drug List (Pa/Pdl) Exemption Request - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-11075 is available for download through this link.

FAQ

Q: What is Form F-11075?
A: Form F-11075 is a Prior Authorization/Preferred Drug List (Pa/Pdl) Exemption Request form in Wisconsin.

Q: What is the purpose of Form F-11075?
A: The purpose of Form F-11075 is to request an exemption from the Prior Authorization/Preferred Drug List (Pa/Pdl) requirements in Wisconsin.

Q: When should Form F-11075 be used?
A: Form F-11075 should be used when a patient requires a medication that is not on the Preferred Drug List (PDL) or needs prior authorization for a certain medication.

Q: Is there a fee to submit Form F-11075?
A: No, there is no fee to submit Form F-11075.

Q: How long does it take to process Form F-11075?
A: The processing time for Form F-11075 varies, but it typically takes up to 15 days for a decision to be made.

Q: What happens if Form F-11075 is approved?
A: If Form F-11075 is approved, the patient will be exempted from the Prior Authorization/Preferred Drug List (Pa/Pdl) requirements for the specified medication.

Q: What happens if Form F-11075 is denied?
A: If Form F-11075 is denied, the patient will need to follow the usual Prior Authorization/Preferred Drug List (Pa/Pdl) process or discuss alternative medication options with their healthcare provider.

Q: Are there any additional requirements for Form F-11075?
A: Yes, the patient's healthcare provider must complete and sign the form, and include any supporting documentation or clinical information.