Get 800 437 3803

Filling out the 800 437 3803 form online is a straightforward process that enables users to submit essential medication prior authorization requests efficiently. This guide offers detailed instructions to help you navigate each section of the form.

Follow the steps to fill out the 800 437 3803 form correctly.

1. Press the ‘Get Form’ button to access the 800 437 3803 form and open it in your online document editor.
2. In the member information section, provide your full name, date of birth, and ID number to accurately identify your record.
3. Complete the prescriber information section by entering the prescriber's name, specialty, phone number, fax number, NPI, street address, city, state, and ZIP code.
4. Fill out the medication information section, including the medication name, strength requested, and indicate if the brand is medically necessary by selecting 'Yes' or 'No'. If 'Yes', be ready to provide additional rationale.
5. Specify the quantity requested, directions for use, and the anticipated length of therapy by selecting from the provided duration options.
6. Indicate the relevant diagnosis and any specialty or injectable medications involved in the request, as well as whether the medication is to be delivered to the physician's office or if it is an office reimbursement request.
7. List any preferred medications you have tried and previous therapies related to this request.
8. Provide a rationale and any additional information that may be relevant for the review of this request.
9. Gather the prescriber signature and date to finalize the document.
10. After completing the form, save your changes, and choose the option to download, print, or share the completed document as needed.

Complete and submit your 800 437 3803 form online today for an efficient authorization process.