Get the free Virginia Premier Non Formulary Exception Request

PRIOR AUTHORIZATION REQUEST FORM EOC ID: Virginia Premier Non-Formulary Exception Request Phone: Medallion 8558720005 OnePlus 8448380711Fax back to: 8667549616EnvisionRx manages the pharmacy drug

How to fill out virginia premier non formulary

How to fill out virginia premier non formulary

1. To fill out the Virginia Premier Non-Formulary form, follow these steps:
2. Start by obtaining a copy of the non-formulary form from Virginia Premier.
3. Read the instructions provided with the form carefully to understand the required details.
4. Gather the necessary information such as the patient's personal details, medical history, and current medications.
5. Consult with the prescribing healthcare provider to understand why the non-formulary medication is needed and discuss alternative options.
6. Fill in the form accurately, providing all the requested information including the patient's identifying information, medication details, and supporting documentation if required.
7. Attach any relevant medical records, lab results, or additional documentation that supports the need for the non-formulary medication.
8. Ensure all the necessary signatures are obtained, including the prescribing healthcare provider's signature and the patient's signature if applicable.
9. Submit the completed form and all supporting documentation to Virginia Premier through the designated submission method as specified in the instructions.
10. Keep a copy of the completed form and all supporting documents for your records.
11. Follow up with Virginia Premier to confirm the receipt of your form and to inquire about the status of the request if needed.

Who needs virginia premier non formulary?

1. Virginia Premier Non-Formulary is typically needed by individuals who require a medication that is not included in Virginia Premier's list of covered drugs, commonly known as the formulary.
2. The non-formulary medication may be prescribed due to various reasons such as medical necessity, lack of suitable alternatives, or specific patient requirements.
3. Patients who have tried and failed other formulary medications or have a documented medical need for a particular non-formulary drug may require Virginia Premier Non-Formulary.
4. It is important to consult with a healthcare provider and Virginia Premier to determine the eligibility and appropriateness of using the non-formulary option.

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What is virginia premier non formulary?

Virginia Premier non formulary is a list of medications that are not covered by Virginia Premier's insurance plans.

Who is required to file virginia premier non formulary?

Healthcare providers and pharmacies are required to file Virginia Premier non formulary when prescribing or dispensing medications that are not on the formulary list.

How to fill out virginia premier non formulary?

To fill out Virginia Premier non formulary, healthcare providers and pharmacies need to indicate the non formulary medication being prescribed or dispensed, along with the reason for choosing that specific medication.

What is the purpose of virginia premier non formulary?

The purpose of Virginia Premier non formulary is to ensure that healthcare providers and patients are aware of medications that are not covered by Virginia Premier's insurance plans.

What information must be reported on virginia premier non formulary?

The information that must be reported on Virginia Premier non formulary includes the non formulary medication name, dosage, quantity, frequency, and the reason for prescribing or dispensing that specific medication.