Get the free Non-Formulary Medications - UPMC Health Plan

NON-FORMULARY MEDICATIONS Prior Authorization Form IF THIS IS AN URGENT REQUEST, please call UPMC Health Plan Pharmacy Services. Otherwise, please return completed form to: UPMC HEALTH PLAN PHARMACY

How to fill out non-formulary medications - upmc

How to fill out non-formulary medications - UPMC?

1. Consult with your healthcare provider: Before filling out a non-formulary medication, it is important to discuss it with your healthcare provider. They will determine if this medication is necessary and suitable for your condition.
2. Obtain a prescription: If your healthcare provider determines that a non-formulary medication is required, they will provide you with a prescription. Make sure to get a written prescription that clearly mentions the name of the medication, dosage instructions, and any special instructions.
3. Check drug coverage: Contact your insurance provider or review your policy to determine if the non-formulary medication is covered. Some insurance plans may partially cover or require prior authorization for non-formulary medications.
4. Prior authorization: If prior authorization is required, your healthcare provider will need to submit a request to your insurance company explaining the medical necessity of the non-formulary medication. The insurance company will review the request and decide whether or not to approve coverage.
5. Consider alternatives: If the non-formulary medication is not covered or the prior authorization is denied, discuss alternative options with your healthcare provider. They may suggest switching to a formulary alternative or exploring other treatment options.

Who needs non-formulary medications - UPMC?

1. Patients with specific medical conditions: Some medical conditions may require non-formulary medications that are not typically covered by insurance. These conditions could include rare diseases, complex chronic conditions, or conditions where formulary alternatives have been ineffective.
2. Patients with allergies or intolerances: In some cases, patients may have allergies or intolerances to certain active ingredients or excipients in formulary medications. In such situations, non-formulary medications may be prescribed to avoid allergic reactions or adverse effects.
3. Patients with unique treatment needs: Non-formulary medications may be prescribed for patients who require specific dosages, combinations, or forms of medication that are not available as formulary options. This could be due to individualized treatment plans or personalized therapies.

Overall, the need for non-formulary medications may vary from patient to patient depending on their medical condition, treatment requirements, and tolerances. It is essential to work closely with healthcare providers and insurance companies to ensure appropriate access and coverage for these medications.

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What is non-formulary medications - upmc?

Non-formulary medications at UPMC are drugs that are not included on the organization's preferred drug list, which means they require special approval to be prescribed.

Who is required to file non-formulary medications - upmc?

Healthcare providers, including physicians and pharmacists, are required to file non-formulary medications at UPMC when they believe a non-formulary drug is necessary for patient care.

How to fill out non-formulary medications - upmc?

To fill out non-formulary medication requests at UPMC, providers must complete a specific form that includes patient information, the reason for the non-formulary request, and any alternative therapies considered.

What is the purpose of non-formulary medications - upmc?

The purpose of non-formulary medications at UPMC is to ensure that patients have access to necessary medications that may not be on the standard formulary while maintaining safe and effective medication use.

What information must be reported on non-formulary medications - upmc?

When reporting non-formulary medications at UPMC, the following information must be included: patient details, medication name, dosage, prescribing provider, reason for use, and any relevant medical history.