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This version of the form is not currently in use and is provided for reference only. Download this version of
Form F-00081
for the current year.
Form F-00081 Prior Authorization / Preferred Drug List (Pa / Pdl) for Opioid Dependency Agents - Buprenorphine - Wisconsin
What Is Form F-00081?
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-00081?
A: Form F-00081 is the Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents - Buprenorphine in Wisconsin.
Q: What is the purpose of Form F-00081?
A: The purpose of Form F-00081 is to request prior authorization for Buprenorphine, which is used in the treatment of opioid dependency.
Q: What does PA/PDL mean?
A: PA/PDL stands for Prior Authorization/Preferred Drug List, which is a process where certain medications require approval from the insurance company before they are covered.
Q: What is Buprenorphine?
A: Buprenorphine is a medication used in the treatment of opioid dependence. It helps reduce cravings and withdrawal symptoms.
Q: Who needs to fill out Form F-00081?
A: Healthcare providers who are prescribing Buprenorphine for the treatment of opioid dependency need to fill out Form F-00081 to request prior authorization.
Q: What information is required on Form F-00081?
A: Form F-00081 requires information such as the patient's name, insurance details, prescriber information, and clinical documentation to support the need for Buprenorphine.
Q: What happens after Form F-00081 is submitted?
A: After submitting Form F-00081, the insurance provider will review the request and determine whether Buprenorphine will be covered under the patient's insurance plan.
Q: What if Form F-00081 is not approved?
A: If Form F-00081 is not approved, the healthcare provider may need to explore alternative treatment options or appeal the decision with additional supporting documentation.
Q: Are there any specific requirements for prescribing Buprenorphine?
A: Yes, healthcare providers need to complete training and obtain a waiver in order to prescribe Buprenorphine for the treatment of opioid dependence.
Form Details:
- Released on July 1, 2021;
- 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-00081 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-00081 Prior Authorization / Preferred Drug List (Pa / Pdl) for Opioid Dependency Agents - Buprenorphine - Wisconsin
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