Managing the treatment of opioid addiction requires careful coordination and adherence to specific medical guidelines. The Suboxone Wellcare form is a critical document in this process, designed to streamline the prescription process for Suboxanereg; and other forms of buprenorphine. This comprehensive form, required to be filled out by physicians with a Drug Addiction Treatment Act (DATA) waiver, gathers essential information about the patient, including their Member ID, name, phone number, diagnosis, and the prescribing physician’s details like DEA and NPI numbers. Physicians must indicate the specific medication and dosage requested, adhering to strict limits that prohibit doses above 32 mg per day. The form prompts for key details related to the patient's treatment history and current status, such as primary diagnosis, recent psychosocial counseling, compliance with treatment sessions, current alcohol use, opioid use within the last 30 days, and reasons for exceeding standard dosing limits, if applicable. It also requires information on planned psychosocial counseling and a urine drug screen. This document must be signed by the physician, certifying their waiver to prescribe these treatments, and submitted via fax to WellCare Pharmacy, signifying a controlled and monitored approach to opioid addiction treatment. By providing a structured format for requesting medication like Suboxone, this form plays a pivotal role in ensuring patients receive the appropriate, sanctioned care for their recovery journey.
| Question | Answer |
|---|---|
| Form Name | Suboxone Wellcare |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | wellmed prior authorization form, uhc wellmed prior authorization form, wellmed provider forms, wellcare frm prior form |
