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State Health Benefits Program PRESCRIPTION DRUG REFILL EXCEPTION REQUEST To request early prescription refills of more than a 34-day or 90-day supply (maximum 12 months), complete this form and send

How to fill out dhrm virginia form

How to fill out prescription drug refill exception:

1. Obtain the necessary form - Contact your healthcare provider or pharmacist to obtain the specific form required for the prescription drug refill exception. They will provide you with the appropriate paperwork to fill out.
2. Provide personal information - Begin by filling out your personal information accurately on the form. This may include your full name, date of birth, address, and contact details. Make sure to double-check the information for accuracy.
3. Specify the medication - Clearly indicate the medication for which you are requesting a refill exception. Include details such as the medication name, dosage, and any other relevant information.
4. State the reason for the exception - Provide an explanation of why you require the prescription drug refill exception. Common reasons may include travel, a change in medication regimen, or other circumstances that prevent you from obtaining the refill in person.
5. Include supporting documentation - If applicable, attach any supporting documentation that supports your request for a refill exception. This could include travel itineraries, medical certificates, or other relevant paperwork that validates your need.
6. Submit the form - Once you have completed the form and attached any necessary documentation, submit it to your healthcare provider or pharmacist. They will review your request and make a determination on whether to approve the refill exception.

Who needs prescription drug refill exception:

1. Patients with chronic conditions - Individuals suffering from chronic health conditions often require regular prescription refills to manage their condition. They might need a refill exception due to travel, difficulties in accessing healthcare, or other circumstances.
2. Individuals with complex medication regimens - Some patients may have complex medication regimens involving multiple prescriptions. They may require a refill exception if they are unable to obtain all the necessary medications within the designated refill period.
3. Those facing unexpected circumstances - Unforeseen circumstances such as sudden travel, natural disasters, or emergencies may necessitate a prescription drug refill exception. In these situations, individuals may be unable to access their regular healthcare provider or pharmacy to obtain a refill.

Remember, it is crucial to consult with your healthcare provider or pharmacist for specific guidelines and procedures regarding prescription drug refill exceptions. They will provide you with the necessary information and ensure that your request is processed appropriately.

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What is prescription drug refill exception?

Prescription drug refill exception allows a patient to refill their prescription medication early under certain circumstances.

Who is required to file prescription drug refill exception?

Healthcare providers are required to submit the prescription drug refill exception on behalf of their patients.

How to fill out prescription drug refill exception?

To fill out a prescription drug refill exception, healthcare providers need to provide justification for the early refill request and submit it to the appropriate authority.

What is the purpose of prescription drug refill exception?

The purpose of prescription drug refill exception is to ensure that patients have timely access to their medication when necessary.

What information must be reported on prescription drug refill exception?

The prescription drug refill exception must include details such as the patient's name, medication, dosage, reason for early refill, and healthcare provider's information.