Get the free Non-formulary drug request - Anthem

NON-FORMULARY DRUG REQUEST Non-formulary requests can be made by members or physicians and must include patient name, ID×, formulary alternatives attempted, and the drug requested. The physician

How to fill out non-formulary drug request

How to fill out non-formulary drug request:

1. Start by obtaining the non-formulary drug request form. This form can usually be found on your insurance company's website or by contacting your healthcare provider.
2. Carefully read and understand the instructions provided on the form. Familiarize yourself with the information required and any supporting documents that may be necessary.
3. Fill in your personal details accurately, including your name, contact information, and insurance policy number. Make sure to provide any additional information requested, such as your healthcare provider's information.
4. Clearly state the drug name, dosage, and quantity you are requesting. Provide relevant reasoning for why this specific non-formulary drug is necessary for your treatment, such as if you have already tried formulary alternatives without success.
5. Attach any supporting documentation that may strengthen your case, such as medical records, test results, or a letter of medical necessity from your healthcare provider. Ensure that these documents are clearly labeled and securely attached to the form.
6. Review the completed form for accuracy and completeness. Make any necessary corrections or additions before submitting it.
7. Submit the non-formulary drug request form as per the instructions provided on the form. This may involve mailing it, faxing it, or submitting it online through your insurance company's portal.
8. Keep a copy of the completed form and any supporting documents for your records.

Who needs non-formulary drug request:

1. Patients who have been prescribed a medication that is not included in their insurance company's formulary list may need to fill out a non-formulary drug request.
2. Individuals who have tried formulary alternatives without success or have specific medical conditions that require a non-formulary drug may also require this request.
3. Healthcare providers may initiate the non-formulary drug request on behalf of their patients to ensure they receive the most appropriate medication for their condition.

For pdfFiller’s FAQs

What is non-formulary drug request?

A non-formulary drug request is a request made by a person to obtain a medication that is not included in the approved list of medications covered by their health plan.

Who is required to file non-formulary drug request?

Any person who wants to obtain a medication that is not covered by their health plan's approved list of medications is required to file a non-formulary drug request.

How to fill out non-formulary drug request?

To fill out a non-formulary drug request, you need to provide your personal information, details about the medication you are requesting, a statement explaining the medical necessity of the medication, and any supporting documents or prescriptions from your healthcare provider.

What is the purpose of non-formulary drug request?

The purpose of a non-formulary drug request is to allow individuals to access medications that are not included in their health plan's approved list of medications, but are necessary for their medical treatment.

What information must be reported on non-formulary drug request?

A non-formulary drug request should include the individual's personal information, details about the medication being requested, a statement explaining the medical necessity, and any supporting documents or prescriptions from a healthcare provider.

How can I send non-formulary drug request for eSignature?

Once you are ready to share your non-formulary drug request, you can easily send it to others and get the eSigned document back just as quickly. Share your PDF by email, fax, text message, or USPS mail, or notarize it online. You can do all of this without ever leaving your account.

Can I edit non-formulary drug request on an Android device?

Yes, you can. With the pdfFiller mobile app for Android, you can edit, sign, and share non-formulary drug request on your mobile device from any location; only an internet connection is needed. Get the app and start to streamline your document workflow from anywhere.

How do I complete non-formulary drug request on an Android device?

Complete non-formulary drug request and other documents on your Android device with the pdfFiller app. The software allows you to modify information, eSign, annotate, and share files. You may view your papers from anywhere with an internet connection.