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Pharmacy and Therapeutics Committee CHI PTC LOG#:___ Date Received:___INSURANCE DRUG FORMULARY ADDITION REQUEST FORM (Healthcare provider) Addition of a dug/ Indication to insurance drug formulary

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How to fill out insurance drug formulary addition

01

Step 1: Obtain the insurance drug formulary addition form from your insurance provider.

02

Step 2: Fill out the required personal information such as name, address, and insurance policy number.

03

Step 3: Provide details of the drug you wish to have added to the formulary including the name, dosage, and frequency of use.

04

Step 4: If necessary, provide supporting documentation from your healthcare provider explaining the need for the drug.

05

Step 5: Submit the completed form to your insurance provider either online, by mail, or in person.

06

Step 6: Follow up with your insurance provider to ensure that the drug has been added to the formulary.

Who needs insurance drug formulary addition?

01

Individuals who require a specific medication that is not currently covered by their insurance plan.

02

Patients with chronic or complex medical conditions that require ongoing medication management.

03

Healthcare providers who want to ensure that their patients have access to necessary medications without financial barriers.

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What is insurance drug formulary addition?

Insurance drug formulary addition is the process of adding new medications to an insurance provider's list of covered drugs.

Who is required to file insurance drug formulary addition?

Insurance providers are required to file insurance drug formulary additions.

How to fill out insurance drug formulary addition?

Insurance drug formulary additions can be filled out online through the insurance provider's portal.

What is the purpose of insurance drug formulary addition?

The purpose of insurance drug formulary addition is to ensure that members have access to necessary medications.

What information must be reported on insurance drug formulary addition?

Information such as drug name, dosage, and reason for addition must be reported on insurance drug formulary addition.

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