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Provigil prior authorization form optumrx 2025

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Select the requested drug Select the diagnosis below Bipolar depression Obstructive sleep apnea/hypopnea syndrome OSAHS Fatigue due to multiple sclerosis MS Narcolepsy Idiopathic hypersomnolence Shift work sleep disorder Major depressive disorder Other diagnosis Yes No Has the diagnosis of narcolepsy been confirmed by a sleep study If a sleep study has not been completed please provide justification why a sleep study would not be feasible Sleep study information If this is a reauthorization req ...

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (176 Votes)
2015	4 Satisfied (46 Votes)
2014	4.4 Satisfied (608 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How does my doctor submit a prescription to OptumRx?

(OptumRx Mail Service) 6800 W 115th St, Suite 600 Overland Park, KS 66211-9838 NCPDP: 1718634 Call 1-800-791-7658 Provide a verbal prescription directly to an Optum Rx provider dedicated pharmacist. Fax 1-800-491-7997 Send a complete prescription using the Physician Fax Form.

How do you use OptumRx at CVS?

Choose between OptumRx home delivery or at nearly 9,700 CVS Pharmacy locations. Your doctor can send an electronic prescription. Register at optumrx.com. Bring in your prescriptions or empty prescription bottles and the pharmacist will do the rest.

Can you use OptumRx at any pharmacy?

If a pharmacy does not contract with Optum Rx, it is considered out of network. You can still fill your prescription at an out-of-network pharmacy, but you may pay more for the same medication.

How to fill a prescription with OptumRx?

How do I fill a new prescription? Fill out an order form. Write the member ID number, patient name and patient date of birth on the back of each prescription. Mail the form to OptumRx.

Does modafinil require prior authorization?

Submit request via: Fax - 1-855-476-4158 All requests for Provigil (modafinil) and Nuvigil (armodafinil) require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below.

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How do I get prior authorization for OptumRx medication?

For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028.

How do I complete a prior authorization?

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.

Provigil prior authorization form optumrx 2025

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How does my doctor submit a prescription to OptumRx?

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Can you use OptumRx at any pharmacy?

How to fill a prescription with OptumRx?

Does modafinil require prior authorization?

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optumrx prior authorization form

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