Updated July 27, 2023
A North Dakota Medicaid prior authorization form allows a medical practitioner to request Medicaid coverage on behalf of a patient for non-preferred drugs in the state of North Dakota. This form issues the specific request and details the prescriber’s justification for making this request. The prescriber should provide any supporting clinical documentation by attaching it to their request form. A PDF version of the North Dakota Medicaid Prior Authorization Form, which can be filled out using either Adobe Acrobat or Microsoft Word, can be downloaded here.
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