Get Formulary Exception Request #p-23282

This guide provides a clear, step-by-step process for completing the Formulary Exception Request #P-23282 online. Whether you are familiar with digital document management or this is your first experience, this guide is designed to assist you in submitting your request accurately and effectively.

Follow the steps to complete your Formulary Exception Request online.

1. Press the ‘Get Form’ button to access the Formulary Exception Request #P-23282. This will allow you to open the form in the editor for completion.
2. Fill in the patient information section with the patient's name, date of birth, and Wellmark ID number. Ensure all details are accurate to prevent processing delays.
3. Provide prescriber information, including prescriber name, NPI, office phone number, address, and fax number. This section verifies the identity of the prescribing professional.
4. In the non-formulary medication information area, enter the medication name, strength, quantity, and relevant ICD-9 code for the diagnosis being treated.
5. Fill out the rationale for exception section by checking the appropriate attestation boxes. Specify details regarding adverse reactions, contraindications, or previous trials with formulary alternatives.
6. If applicable, complete the required explanation that demonstrates how the requested medication is necessary for the patient's condition and provide any supporting details.
7. Indicate if the request is clinically urgent by checking 'Yes' or 'No.' Make sure to understand the definition of a clinically urgent situation to ensure proper processing.
8. Once all sections are completed, review the form for accuracy. Save your changes and either download a copy, print the form for your records, or share it with the necessary parties.

Complete your Formulary Exception Request #P-23282 online today to ensure proper handling of your medication needs.