Specific Optum Rx Prior Authorization Form to Request Specific Drug


Requesting drugs can’t be simpler with Optum Rx prior authorization form. OptumRX is a healthcare service provider company. OptumRX provides special medication to the customers whether it is covered by the Medicare or not. There are various drugs which can be requested from OptumRX. Like all the prior authorization, the forms need to be filled with the prescriber’s data and the patient needs to consult with doctors before making such a request.

What to Fill in Optum Rx Prior Authorization Form

The Optum Rx prior authorization form can be used to request to request medications. There is also special prior authorization form to request specific drugs, like Optum Rx prior authorization form for Adderall. The general prior authorization form needs to be filled with the patient’s name. Fill the patient’s name, insurance number, date of birth, contact number, and many more. Then fill the provider information. It is better if your provider is also your doctor so you can always easily consult with your doctor and control your medication. Fill his name, ID number, address, and many more. For the medication instruction section, it should be filled by your doctor. The sections include the name of medications, medication quantity, directions, and diagnosis. The ICD-9 on the form can be filled with the code of the disease. Then there is medication instructions section. Your doctor needs to fill this section to support your medication request. Then you can choose where the drug will be sent.

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The general Optum Rx prior authorization also needs additional form which will include the patient’s detailed diagnosis information. It is usually whether the patient has certain sensitivity about some medication or failing drugs. The side effect of such failure will be recorded on the form.

Optum Rx Prior Authorization Form: Conclusion

OptumRX provides the customer with various medications which can be requested by filling Optum Rx prior authorization form. It is easy to fill and provide great details. The form is compact and still able to explain the disease. In case the prescriber needs to include more information, Optum Rx prior authorization can be attached with specialty form which provides the patients detailed information about the disease.

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