Get the free Non-Formulary Exception Prior Authorization Form - HMSA.com

PRIOR AUTHORIZATION REQUEST Global Formulary Criteria PATIENT:Name Address: City, State, Zip D.O.B. Member ID:Prescriber:_Medication Requested:Name Address City, State, Zip Phone Fax Piety Requested:mm_name1

How to fill out non-formulary exception prior authorization

How to fill out non-formulary exception prior authorization

1. Start by obtaining the non-formulary exception prior authorization form from your insurance provider. You can usually find this form on their website or by contacting their customer service.
2. Read the instructions on the form carefully to ensure you understand all the requirements and guidelines for filling it out.
3. Begin filling out the form by providing your personal and insurance information, such as your name, date of birth, policy number, and contact details.
4. Next, provide details about the medication for which you are seeking an exception. This may include the name of the medication, dosage, frequency of use, and the reason why the medication is necessary for your health condition.
5. Attach any supporting documents or medical records that can provide additional evidence of the medical necessity for the non-formulary medication.
6. Review the completed form for accuracy and completeness before submitting it to your insurance provider.
7. Follow up with your insurance provider to ensure they have received your request and to inquire about the status of your non-formulary exception prior authorization.
8. Keep copies of all the documents submitted and any communication or correspondence with your insurance provider for future reference.

Who needs non-formulary exception prior authorization?

1. Anyone who has a prescription for a medication that is not included in their insurance's formulary will typically need to go through the process of obtaining a non-formulary exception prior authorization.
2. This includes individuals whose prescribed medication is not on the list of covered drugs provided by their insurance provider or individuals who have been recommended a non-formulary medication by their healthcare provider for specific medical reasons.
3. It is important to note that the specific eligibility criteria for non-formulary exception prior authorization may vary between insurance providers, so it is advisable to consult your insurance policy or contact your insurance provider directly for more information.

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What is non-formulary exception prior authorization?

Non-formulary exception prior authorization is a request made to obtain coverage for a medication that is not on the formulary list of approved medications.

Who is required to file non-formulary exception prior authorization?

Patients or medical providers are required to file non-formulary exception prior authorization.

How to fill out non-formulary exception prior authorization?

Non-formulary exception prior authorization can be filled out by submitting a form with the required information and supporting documentation.

What is the purpose of non-formulary exception prior authorization?

The purpose of non-formulary exception prior authorization is to ensure that patients have access to necessary medications that are not typically covered by insurance.

What information must be reported on non-formulary exception prior authorization?

Information such as medical necessity, previous treatments, and supporting documentation from healthcare providers must be reported on non-formulary exception prior authorization.