Get the free Prior Authorization and Formulary Exception Request Form (OHP only)

Prior Authorization / Formulary Exception Request Form Revised December 2018 Please fax form to 5034168109To find out if a drug is covered or what would be covered on the formulary as an alternative,

How to fill out prior authorization and formulary

How to fill out prior authorization and formulary

1. To fill out a prior authorization form, follow these steps:
2. Obtain the prior authorization form from your healthcare provider, insurance company, or pharmacy.
3. Fill in your personal details, including your name, date of birth, and insurance information.
4. Provide information about the medication you are requesting prior authorization for, including the name, dosage, and quantity.
5. Include supporting documentation such as medical records, test results, or a letter of medical necessity from your healthcare provider.
6. Submit the completed form and supporting documents to your insurance company either online, by fax, or by mail.
7. To fill out a formulary, follow these steps:
8. Obtain the formulary list from your insurance company or pharmacy.
9. Look up the medication you are interested in to determine if it is covered by your insurance.
10. Note any restrictions, such as prior authorization requirements or quantity limits.
11. If your medication is not covered or has restrictions, consult with your healthcare provider or insurance company to discuss alternative options.
12. Keep the formulary list handy for future reference when discussing prescription options with your healthcare provider or pharmacist.

Who needs prior authorization and formulary?

1. Prior authorization and formulary requirements can vary depending on the insurance plan and medication being prescribed.
2. Generally, patients who are prescribed medications that are expensive or have specific criteria for coverage may need prior authorization.
3. Patients who want to ensure that their prescribed medication is covered by their insurance plan should check the formulary list.

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What is prior authorization and formulary?

Prior authorization is the process of obtaining approval from the insurance company before a medication or procedure can be covered. A formulary is a list of medications that are covered by a specific insurance plan.

Who is required to file prior authorization and formulary?

Healthcare providers such as doctors and pharmacists are typically required to file prior authorization and formulary.

How to fill out prior authorization and formulary?

To fill out prior authorization and formulary, healthcare providers need to provide detailed information about the patient, the medication or procedure being requested, and the medical necessity for it.

What is the purpose of prior authorization and formulary?

The purpose of prior authorization and formulary is to control costs, ensure appropriate use of medications and procedures, and to promote quality healthcare.

What information must be reported on prior authorization and formulary?

Information such as patient demographics, medical history, diagnosis, prescribed medication or procedure, and any relevant supporting documentation must be reported on prior authorization and formulary.