gateway prescription auth for proton inhibitor
Instructions: Type or print clearly. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets Completion Instructions, F-00433A. Providers may refer to the Forms page of the ForwardHealth Portal at www.forwardhealth.wi ...eywords. dhs, department health services, dhcaa, division health care access and accountability, bbm, bureau benefits management, pharmacy, f-00433, prior authorization/preferred drug list (pa/pdl) proton pump inhibitor (ppi) orally disintegrating tablets. Last modified by.