Get 888 346 5701

Filling out the 888 346 5701 form is essential for submitting pharmacy requests such as prior authorizations or formulary exceptions. This guide will provide you with a step-by-step approach to ensure that you complete the form accurately and efficiently.

Follow the steps to accurately complete the form.

1. Press the ‘Get Form’ button to access the document and open it in your selected interface.
2. Begin by selecting the request type. You will need to check either 'Prior authorization' or 'Tiering or formulary exception' based on your needs.
3. If the request is urgent, ensure the physician or prescriber signs where indicated to expedite the review.
4. Fill out the member information section, including their name, member ID number, date of birth, and phone number.
5. Complete the prescriber information section with the prescriber's name, specialty, phone number, fax number, and office contact details.
6. In the medication request section, provide the drug name, strength, quantity required, SIG (directions), days supply, route of administration, duration of therapy, and the number of refills needed.
7. List the diagnosis or diagnoses related to the medication request, including any applicable ICD codes.
8. For prior authorization and exception requests, provide detailed clinical information or reasoning for the request.
9. If applicable, select one of the supporting statements regarding formulary alternatives to justify the request.
10. Ensure the prescriber signs and dates the form at the designated location.
11. If additional information is necessary, prepare a separate sheet to include with the form.
12. After completing the form, you can save your changes, download it, or print it. Finally, fax the completed form to the appropriate number.

Complete your pharmacy request form online to ensure timely processing.