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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMBronchodilators Beta Agonist Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient.

How to fill out non-formulary drug prior authorization

How to fill out non-formulary drug prior authorization

1. Contact your healthcare provider or pharmacist to request a non-formulary drug prior authorization form.
2. Fill out the patient and prescriber information sections of the form.
3. Provide detailed information about the medication, such as the name, dosage, and frequency of use.
4. Include a statement explaining why the non-formulary drug is medically necessary for your condition, and provide any supporting documentation or research if available.
5. Submit the completed form to your healthcare provider or insurance company, following their specified submission process.
6. Wait for a response from your insurance company regarding the approval or denial of the prior authorization request.
7. If approved, follow any additional instructions provided by your insurance company or healthcare provider.
8. If denied, you may have the option to file an appeal or explore alternative medication options with your healthcare provider.

Who needs non-formulary drug prior authorization?

1. Individuals who need non-formulary drugs that are not covered by their insurance plan.
2. Patients whose healthcare provider has determined that a non-formulary drug is medically necessary for their condition.

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What is non-formulary drug prior authorization?

Non-formulary drug prior authorization is a process that requires healthcare providers to obtain approval from a health insurance plan before a non-formulary medication is prescribed and dispensed to ensure coverage.

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

Healthcare providers, such as doctors or pharmacies, are required to file non-formulary drug prior authorization on behalf of the patient.

How to fill out non-formulary drug prior authorization?

To fill out a non-formulary drug prior authorization, providers typically need to complete a specific form provided by the insurance company, including patient information, medication details, diagnosis, and justification for the non-formulary drug.

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

The purpose of non-formulary drug prior authorization is to control costs, ensure patients receive appropriate medication, and avoid unnecessary treatments by requiring justification for using non-formulary drugs.

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

Information required includes patient demographics, medication name and dosage, diagnosis, previous treatments, rationale for choosing the non-formulary medication, and any supporting medical documentation.