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STEP THERAPY DRUG REQUEST FORM (Incomplete form may delay processing) Prescriber Information Prescriber Name: Patient Information Provider ID/Tax ID : Patient Name: Office Contact Person: BCB SNC
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How to fill out step therapy drug request
How to fill out a step therapy drug request:
01
Start by obtaining the step therapy drug request form from your healthcare provider or insurance company.
02
Read the form thoroughly to understand the required information and instructions.
03
Fill in your personal details accurately, including your name, address, phone number, and insurance information.
04
Provide information about the prescribed medication that you are requesting, such as the name, dosage, and frequency.
05
Include a brief explanation of why you believe the prescribed medication is necessary and why you should be exempted from step therapy requirements.
06
If applicable, attach any supporting documents or medical records that justify your request.
07
Review the completed form for any errors or missing information before submitting it to your healthcare provider or insurance company.
Who needs a step therapy drug request?
01
Patients who have been prescribed a medication that requires step therapy by their insurance plan.
02
Individuals who have tried and failed alternative, less expensive or preferred drugs before receiving coverage for the prescribed medication.
03
Patients with specific medical conditions that necessitate a particular drug that is not normally covered by their insurance plan without step therapy.
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