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AETNA BETTER HEALTHNonFormulary Prior Authorization guideline for Drugs Covered (extended release injection)Authorization guidelines patients who meet all the following: Must be at least 18 years

How to fill out non-formulary prior authorization guideline

How to fill out a non-formulary prior authorization guideline:

1. Gather the necessary information: Begin by collecting all relevant details about the medication for which prior authorization is being sought. This includes the name of the medication, dosage information, and the reason for prescribing it.
2. Access the non-formulary prior authorization form: Contact your insurance provider or access their online portal to obtain the non-formulary prior authorization form. This form will outline the specific information and documentation required for the approval process.
3. Review the form instructions: Carefully read through the instructions provided on the form. Pay close attention to any specific guidelines or documentation that may be necessary to support the prior authorization request.
4. Complete all required sections: Fill in all sections of the form accurately and completely. Provide the necessary information about the patient, prescriber, and pharmacy involved. Include details about the patient's medical history, previous treatments, and any failed trials with formulary alternatives.
5. Attach supporting documentation: In order to strengthen the prior authorization request, include any relevant supporting documentation. This may include medical records, test results, or a statement of medical necessity from the prescribing healthcare provider.
6. Submit the completed form: Once fully filled out, submit the completed non-formulary prior authorization form according to the instructions provided. This may involve faxing or mailing the form, or submitting it through an online portal if available.

Who needs non-formulary prior authorization guideline?

1. Patients with specific medication needs: Individuals who require medications that are not part of their insurance provider's formulary may need to go through the non-formulary prior authorization process. This includes medications that are not typically covered or require additional verification for coverage.
2. Prescribing healthcare providers: Physicians, nurse practitioners, and other healthcare professionals who prescribe non-formulary medications to their patients will need to navigate the prior authorization process. They must familiarize themselves with the specific guidelines and procedures outlined by insurance providers.
3. Pharmacists and pharmacy staff: Pharmacies that dispense non-formulary medications are involved in the prior authorization process as well. Pharmacists and their staff may need to provide assistance in gathering the necessary documentation and completing the prior authorization form.

It is important to note that the specific requirements for non-formulary prior authorization may vary depending on the insurance provider and the medication in question. It is advisable to consult with the insurance provider or review their guidelines to ensure accurate completion of the prior authorization process.

For pdfFiller’s FAQs

What is non-formulary prior authorization guideline?

Non-formulary prior authorization guideline is a set of rules and requirements that must be followed in order to obtain approval for medication that is not on the formulary list.

Who is required to file non-formulary prior authorization guideline?

Healthcare providers and pharmacies are typically required to file non-formulary prior authorization guidelines.

How to fill out non-formulary prior authorization guideline?

Non-formulary prior authorization guidelines are typically filled out online or through a specific form provided by the insurance company.

What is the purpose of non-formulary prior authorization guideline?

The purpose of non-formulary prior authorization guidelines is to ensure that medications not on the formulary list are used appropriately and only when necessary.

What information must be reported on non-formulary prior authorization guideline?

Information such as patient demographics, medical history, previous medication trials, and rationale for prescribing a non-formulary medication must be reported.

How do I complete non-formulary prior authorization guideline online?

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