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The document is a CIGNA HealthCare Prior Authorization Form for the medication Enbrel (Etanercept). It outlines the necessary information required from healthcare providers and patients to process requests for prior authorization, including provider and patient details, medication dosage, diagnosis, and previous treatment history. The form emphasizes the importance of completing all sections to avoid delays or adverse determinations and provides contact information for submission and inquiries.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Provider Information' section. Enter your name, specialty, DEA or TIN, office contact person, and phone details.
Next, complete the 'Patient Information' section. Ensure you provide all asterisked (*) items such as patient name, CIGNA ID, date of birth, and address.
In the 'Medication Requested' field, select the appropriate Enbrel dosage and specify the duration of therapy along with any relevant J-Code.
Indicate where the medication will be obtained by selecting from options like retail pharmacy or CIGNA Tel-Drug.
For diagnosis related to use, check all applicable conditions such as Rheumatoid Arthritis or Psoriatic Arthritis.
Finally, review all sections for completeness before submitting via fax at (800)390-9745. Ensure that all required fields are filled to avoid delays.

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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.

Can a doctors office charge for prior authorization?

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider. As mentioned in the How does prior authorization work? section above, this will then often prompt a time-consuming back and forth between the provider and payer.

Can I fill a prescription without prior authorization?

Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)

What happens if you dont get prior authorization?

If you dont get permission from your health plan, your health insurance wont pay for the service. Youll be stuck paying the bill yourself.

Why do prescriptions need prior authorization?

Prior authorizations are usually only required for more costly, involved treatments where an alternative is available. For instance, if a physician prescribes an invasive procedure such as orthopedic surgery, it will likely require preauthorization.

What prior authorization is needed for Wegovy?

If you need prior authorization, your doctors office will process the request for you at no charge. They will follow up with your insurance company until the request is approved or denied. This process can involve a great deal of back and forth.