Then, they automatically authorize a 90 day supply every 90 days after that up to a year. There is no co-payment. Initiating Enrollment Doctor can be registered by phone. If the need is immediate, doctor is told to give the patient a prescription and have pharmacist call the 800 number to get benefit processing information and authorization to dispense the medication. Health Provider's Role Calls in the patient's name, address, DOB, SSN, number of individuals in the household, household income and source, and fixed monthly medical expenses.
Doctor provides the name of the medication, dosage and strength.
On lower left, of form, there's a card the patient takes to pharmacy and immediately gets a 30 day supply. Doctor and patient. Patient's Role Pt. or family member must go to doctor's office to pick up initial card and to complete and sign the patient section of the form. The patient must advise the physician of any changes in household income or insurance coverage. Not specified Refills The company automatically sends forms for renewal every 90 dyas.