Get the free THP Member Exigent Non-Formulary Pharmacy Request Form

Member Exigent Formulary Pharmacy Request Form This form is only used for Small and Individual Group Commercial Members who are requesting a formulary exception under exigent circumstances. An exigent

How to fill out thp member exigent non-formulary

How to fill out THP member exigent non-formulary:

1. Acquire the necessary forms: Start by obtaining the THP member exigent non-formulary form from your healthcare provider or insurance company. This form is typically required when a medication is not included in the plan's formulary.
2. Provide personal information: Fill in your personal details such as name, address, date of birth, and insurance policy number. Ensure that all information is accurate and up to date.
3. Prescribing physician information: Provide the name, contact details, and specialty of the prescribing physician who has recommended the non-formulary medication. This information helps the insurance company verify the necessity of the medication.
4. Reason for the request: Clearly state the medical reason why the non-formulary medication is required. This can include allergies, adverse reactions to formulary alternatives, previous treatment failures, or specific medical conditions that necessitate the requested medication.
5. Supporting documentation: Include any relevant medical records, test results, or reports that support the need for the non-formulary medication. These documents help justify the request and increase the likelihood of approval.
6. Alternative treatments tried: Specify any formulary alternatives that have already been attempted and failed or caused intolerable side effects. This information demonstrates your efforts to find suitable alternatives before resorting to the non-formulary medication.
7. Physician's justification: Ask your prescribing physician to provide a detailed explanation of why the non-formulary medication is necessary for your specific medical condition. This justification should outline the potential benefits, risks, and expected outcomes of the requested treatment.

Who needs THP member exigent non-formulary?

1. Individuals requiring specific medications: THP member exigent non-formulary is needed by individuals who have been prescribed medications that are not included in their healthcare plan's formulary. This can occur when a medication is relatively new, expensive, or not commonly used.
2. Patients with unique medical conditions: Certain medical conditions may require specialized medications that are not typically covered by insurance plans. In these cases, individuals with these unique medical conditions may need to request the THP member exigent non-formulary to receive the necessary treatment.
3. Those who have exhausted formulary options: Individuals who have tried and failed with the available formulary alternatives may require the THP member exigent non-formulary. This ensures that they can access medications that are not on the formulary but are crucial for their health and well-being.

Note: It is essential to check with your insurance provider to understand their specific requirements and procedures for filling out the THP member exigent non-formulary form.

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What is thp member exigent non-formulary?

Thp member exigent non-formulary is a formulary for requesting urgent access to medications not on the health plan's list of covered drugs.

Who is required to file thp member exigent non-formulary?

Members who need urgent access to medications not on the health plan's formulary are required to file thp member exigent non-formulary.

How to fill out thp member exigent non-formulary?

To fill out thp member exigent non-formulary, members must provide information about the prescribed medication, the reason for urgency, and the supporting documentation from the prescribing physician.

What is the purpose of thp member exigent non-formulary?

The purpose of thp member exigent non-formulary is to expedite the review and approval process for accessing non-formulary medications in urgent situations.

What information must be reported on thp member exigent non-formulary?

Information such as the prescribed medication, reason for urgency, supporting documentation from the prescribing physician, and member's medical history must be reported on thp member exigent non-formulary.