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1. Click ‘Get Form’ to open the Medication Prior Authorization Form in the editor.
2. Begin by filling out the PHYSICIAN INFORMATION section. Enter the Physician Name and Specialty as required.
3. Next, complete the PATIENT INFORMATION section. Ensure all asterisked (*) items are filled out, including Patient Name, Cigna ID, Date of Birth, and Patient Street Address.
4. Indicate the urgency of the request by selecting either 'Standard' or 'Urgent'. If urgent, confirm that applying standard review time may jeopardize the patient’s health.
5. Provide details about the medication requested, including name, strength, dosing schedule, duration of therapy, and quantity.
6. Answer questions regarding alternative medications and treatments. Provide detailed information for each trial if applicable.
7. Finally, include any additional pertinent information that may support your request before submitting the form.

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