Get the free 9.002 Mandatory Generic Substitution PA Form.doc. Federal Tort Claims Act Handbook -...
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Clinical Justification Mandatory Generic Substitution Fax to INFORMED PA Dept. 1-866-795-8834 INFORMED Phone Number 1-866-795-0049 Product Applicability: IMS Health Commonwealth Care Commercial PRESCRIBER
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How to fill out 9002 mandatory generic substitution
How to fill out 9002 mandatory generic substitution:
01
Begin by gathering all relevant information about the prescribed medication and the generic substitution requirements. This includes the brand name, dosage, quantity, and any specific instructions given by the healthcare provider.
02
Consult the 9002 mandatory generic substitution form provided by your healthcare or insurance provider. This form may be available online or at a local pharmacy.
03
Fill in the required personal information, such as your name, address, date of birth, and insurance details. Make sure to provide accurate and up-to-date information to avoid any complications or delays.
04
Identify the prescribed medication for which you are requesting a generic substitution. Specify the brand name, dosage, and quantity as indicated in the prescription.
05
Provide any necessary supporting documentation, if required. This may include a letter from your healthcare provider explaining the necessity of the generic substitution or any relevant medical reports.
06
Sign and date the form, confirming that all the information provided is accurate and complete.
07
Submit the completed 9002 mandatory generic substitution form to your healthcare provider, insurance company, or pharmacy as instructed. Keep a copy of the form for your records.
Who needs 9002 mandatory generic substitution?
01
Individuals who have certain health insurance plans that specifically require or promote the use of generic medications may need to fill out the 9002 mandatory generic substitution form.
02
Patients who have been prescribed a brand-name medication but wish to request a generic substitution to reduce their out-of-pocket expenses may need to utilize this form.
03
Healthcare providers or pharmacists who are required to confirm and document the patient's consent for generic substitution may also need to utilize this form.
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