Instructions for Form F-02433 Prior Authorization / Preferred Drug List (Pa / Pdl) for Epidiolex - Wisconsin

Instructions for Form F-02433 Prior Authorization / Preferred Drug List (Pa / Pdl) for Epidiolex - Wisconsin

This document contains official instructions for Form F-02433 , Prior Authorization/Preferred Drug List (Pa/Pdl) for Epidiolex - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-02433 is available for download through this link.

FAQ

Q: What is Form F-02433?
A: Form F-02433 is a prior authorization/preferred drug list form for Epidiolex in Wisconsin.

Q: What is the purpose of Form F-02433?
A: The purpose of Form F-02433 is to request prior authorization for the use of Epidiolex or to include it on the preferred drug list in Wisconsin.

Q: What is prior authorization?
A: Prior authorization is a process in which healthcare providers must get approval from the insurance company before prescribing a specific medication.

Q: What is a preferred drug list?
A: A preferred drug list is a list of medications that are preferred by an insurance company or pharmacy benefit manager, usually because they are cost-effective or have demonstrated clinical benefits.

Q: What is Epidiolex?
A: Epidiolex is a prescription medication that contains cannabidiol (CBD) and is approved by the FDA for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome.

Q: Who needs to use Form F-02433?
A: Healthcare providers who want to prescribe Epidiolex in Wisconsin need to use Form F-02433 to request prior authorization or include it on the preferred drug list.

Q: What information is required on Form F-02433?
A: Form F-02433 requires information such as patient details, medical diagnosis, healthcare provider information, medication details, and any supporting clinical documentation.

Q: How long does it take to get a response to a prior authorization request?
A: The response time for a prior authorization request may vary, but it typically takes a few business days to receive a decision from the insurance company or pharmacy benefit manager.

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Instruction Details:

  • This 3-page document is available for download in PDF;
  • Actual and applicable for the current year;
  • Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.

Download Instructions for Form F-02433 Prior Authorization / Preferred Drug List (Pa / Pdl) for Epidiolex - Wisconsin

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