Get Brand Over Generic Prior Authorization Request Form

Filling out the Brand Over Generic Prior Authorization Request Form is a crucial step for users seeking authorization for brand-name medications when generics are available. This guide will provide you with clear, detailed steps to complete the form online efficiently.

Follow the steps to complete your form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully enter the patient and physician information in the designated fields. This includes the patient’s name, date of birth, address, and phone number, as well as the physician’s name, address, secure fax number, and the Sponsor ID number.
3. Indicate which medication is being prescribed by writing the name of the medication in the specified field.
4. Answer the questions regarding the patient's experience with the generic product. Indicate if the patient has tried the generic product by selecting 'Yes' or 'No'. If 'Yes', provide an explanation of the patient’s experience, otherwise, provide patient-specific clinical justification for why the A-rated generic product cannot be used.
5. Once all the required fields are completed, review the form for accuracy. After verifying the information, the prescriber should sign and date the form in the designated signature field.
6. Finally, save any changes you made to the form. You may also choose to download, print, or share the completed form as necessary.

Complete your documents online today for a smooth authorization process.