№ lp_1_2_50401
This form is used by healthcare providers to request prior authorization for preventive treatment drugs for headache agents, including migraines, within the Medicaid system in Wisconsin.
Year: 2022
Region / City: Wisconsin
Subject: Health services, medication, migraine treatment
Document Type: Form
Institution: Department of Health Services, State of Wisconsin
Author: Department of Health Services
Target Audience: Healthcare providers, prescribers, pharmacy providers
Effective Period: Not specified
Approval Date: Not specified
Amendment Date: Not specified
Price: 8 / 10 USD
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