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

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Prior Authorization / Formulary Exception Request Form Revised January 2018 Please fax form to 5034168109For assistance with this form, call Care Oregon Advantage at 5034164279 or toll-free at 8887123258,

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How to fill out prior authorization and formulary

01

Obtain the prior authorization form from your healthcare provider or insurance company.

02

Fill out all required personal information, such as name, date of birth, and insurance policy number.

03

Provide details about the medication being requested, including the name, dosage, and reason for needing prior authorization.

04

Have your healthcare provider complete any necessary sections of the form, including providing clinical information or supporting documentation.

05

Submit the completed form to your insurance company through the designated method, such as fax, mail, or online portal.

Who needs prior authorization and formulary?

01

Patients who are prescribed medications that require prior authorization from their insurance company.

02

Healthcare providers who are prescribing medications that are not on the formulary list of covered medications by the insurance company.

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What is prior authorization and formulary?

Prior authorization is a process used by insurance companies to determine if they will cover a prescribed medication or procedure. A formulary is a list of covered medications that insurance companies will pay for.

Who is required to file prior authorization and formulary?

Healthcare providers are usually required to file prior authorization for medications or procedures that require it. Insurance companies will also maintain and update formularies.

How to fill out prior authorization and formulary?

Healthcare providers need to complete the necessary forms provided by the insurance company and submit them along with supporting documentation such as medical records.

What is the purpose of prior authorization and formulary?

The purpose is to ensure that patients receive appropriate and cost-effective care, while also managing the costs of healthcare services for insurance companies.

What information must be reported on prior authorization and formulary?

Information such as patient diagnosis, prescribed medication or procedure, medical necessity, and supporting documentation must be reported.

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