Get the free Step Therapy Exception Form - Paramount
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To request an expedited review simply indicate this at the top of this page. Medical Justification Please provide medical justification for the step therapy exception request. I attest that the information provided on this form is true and accurate as of this date Prescriber s signature Date. Step therapy drugs are formulary drugs that are covered only if certain first-line formulary alternatives have been tried first. An expedited review is available if you certify that a standard review...
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How to fill out step therapy exception form
How to fill out step therapy exception form
01
Read the instructions provided with the step therapy exception form.
02
Gather all the necessary information required for the form.
03
Fill in your personal details, such as name, address, phone number, etc.
04
Provide information about your current medication and the reason for requesting an exception.
05
Attach any supporting documentation, such as medical records or a doctor's note.
06
Review the completed form for accuracy and completeness.
07
Submit the form to the relevant authority or insurance company.
08
Follow up with the authority or insurance company to check the status of your exception request.
Who needs step therapy exception form?
01
Patients who have been prescribed a medication that requires step therapy by their insurance provider.
02
Patients who believe they have a valid reason to bypass the step therapy process.
03
Patients who have tried and failed with the preferred medications prescribed under step therapy.
04
Patients whose healthcare provider believes that the step therapy requirements are not medically appropriate for their condition.
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