Get - Express Scripts

This guide provides clear instructions on how to complete the - Express Scripts form for effectively and efficiently. By following the outlined steps, you can ensure that all necessary information is accurately submitted for prior authorization.

Follow the steps to complete the - Express Scripts form successfully.

1. Press the ‘Get Form’ button to access the online version of the - Express Scripts form and open it for editing.
2. Fill in the patient information section, including the first name, last name, date of birth, and patient ID number.
3. Provide the prescriber information, including their name, DEA/NPI number, phone number, fax number, and address.
4. Indicate the primary diagnosis and the corresponding ICD code.
5. Select the specific product and strength being requested from the given options.
6. Enter the directions for use, specifying how often the medication should be applied and the quantity needed.
7. Answer the questions regarding the indication or diagnosis, and provide any necessary details if conditions are not listed.
8. Complete the additional section regarding prior therapies attempted for acne vulgaris if applicable.
9. Include any other relevant comments or information that may assist in the review.
10. Have the prescriber sign and date the form, and fill in the contact name and phone number of the office.
11. After verifying all information is complete and accurate, save the changes, and consider downloading, printing, or sharing the form as needed.

Complete your Express Scripts forms online today for a seamless submission process.