There are certain prescription medications that require prior-authorization by MDM. This is often the case for medications that can be used to treat more than one condition. If you receive the message "Submit manual, Dr's explanation req'd", please call our office at 1-800-838-1531 to have a personalized Prior-Authorization form for your patient faxed to your pharmacy. Our forms are diagnosis based, therefore we will need to know the diagnosis in order to provide you with the correct form.
Prior-Authorization forms must be completed by both the patient and the prescribing physician. Additionally, we would also require a 12 month drug history from the Pharmacy or Doctor to be submitted along with the completed Prior-Authorization form. Once fully completed, this form may be submitted to our office for consideration by:
Fax: 519-836-4909
Mail: MDM lnsurance Services lnc. P.O. Box #970, Guelph, Ontario N1H 6N1
Email: [email protected]
A list of the most common Prior-Authorization medications can be accessed by clicking on the below link. Please note that this list does not include all drugs in this category, but is updated as new drugs are introduced to the market.