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Nonstandard Formulation Essential Formulary PRIOR REVIEW/CERTIFICATION FATBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER
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Start by carefully reading the instructions provided on the formulary.
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Fill out your personal information such as name, address, contact details, and date of birth.
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Individuals who require specialized or personalized medication formulations.
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Patients with unique medical conditions that necessitate tailored treatment options.
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Healthcare providers who are prescribing medications that are not readily available in standard formularies.
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Non-standard formulationessential formulary is a document that lists medications not included in the standard formulary of a healthcare provider.
Healthcare providers and institutions are required to file non-standard formulationessential formulary.
Non-standard formulationessential formulary can be filled out by listing the non-standard medications prescribed to patients.
The purpose of non-standard formulationessential formulary is to track and monitor the usage of non-standard medications within a healthcare institution.
Non-standard formulationessential formulary must include the names of non-standard medications, dosages, frequency of use, and the prescribing healthcare provider.
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