Get Minnesota Uniform Formulary Exception Form - Ucare - Ucare

Filling out the MINNESOTA UNIFORM FORMULARY EXCEPTION FORM - UCare - Ucare is essential for healthcare providers seeking exceptions from group purchaser formularies. This guide provides thorough instructions to help users complete the form accurately and efficiently, ensuring smooth processing of requests.

Follow the steps to complete the form effectively.

1. Utilize the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin filling out Section A, which requires information about the group purchaser. Provide the group purchaser's name and contact details such as address and contact number.
3. Proceed to Section B to enter patient information. Include the patient's full name, date of birth, address, and health plan or pharmacy plan details along with the corresponding ID numbers.
4. Move to Section C and fill in the prescriber information. This includes the prescriber's name, NPI, specialty, and contact details for both the prescriber and the clinic or facility.
5. In Section D, input the medication information by stating the drug being requested along with its strength and dosing schedule. Specify the duration of therapy expected.
6. Answer the questions in Section E regarding current treatments and initial therapy dates, providing any necessary clinical information.
7. Complete Section F, the rationale for the formulary exception request. This section asks for previous therapies tried, their outcomes, and any additional clinical information that may support the request.
8. Finally, review all sections for completeness and accuracy. Once finalized, save your changes. You can then download, print, or share the completed form as needed.

Ensure to fill out your documents online for a streamlined experience.