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Este formulario se utiliza para solicitar la revisión para la adición o eliminación de un medicamento en el formulario de medicamentos de Kaiser Permanente Mid-Atlantic States. Los miembros del plan de salud KPMAS, el Grupo Médico Permanente de Mid-Atlantic y otros proveedores pueden enviar solicitudes.

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What is formulary addition/deletion request?

A formulary addition/deletion request is a formal request submitted to include or remove a medication from a health plan's formulary, which lists approved drugs for coverage.

Who is required to file formulary addition/deletion request?

Pharmaceutical companies, healthcare providers, or pharmacy benefit managers are typically required to file a formulary addition/deletion request.

How to fill out formulary addition/deletion request?

To fill out a formulary addition/deletion request, one must provide detailed information about the medication, its clinical data, cost-effectiveness, and justification for the request.

What is the purpose of formulary addition/deletion request?

The purpose of a formulary addition/deletion request is to ensure that medications are accurately reviewed for inclusion or exclusion from a formulary based on medical efficacy, safety, and cost.

What information must be reported on formulary addition/deletion request?

The information that must be reported includes the drug's name, indication, clinical trial data, adverse effects, pricing information, and rationale for the addition or deletion.

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