Get - Express Scripts

Filling out the Express Scripts prior authorization form for Beta Blocker Step Therapy is a critical step for ensuring that your medication request is processed efficiently. This guide provides a clear, step-by-step approach to help users complete the form accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the patient's first and last name in the designated fields. Ensure that this information matches the patient's official records.
3. Input the patient's ID number, date of birth, and contact details in the respective sections.
4. Next, provide the prescriber's information, including their name, DEA/NPI number, phone number, and fax number. The DEA/NPI is mandatory for processing.
5. Complete the patient’s primary diagnosis along with the corresponding ICD code, which may be required by the insurance provider.
6. Select the requested medication and strength from the provided list, marking the appropriate checkbox for the chosen option.
7. Specify the directions for use, detailing the frequency and quantity as necessary.
8. Answer the clinical assessment questions accurately. This includes confirming whether the patient is currently taking the requested medication and if they are paying out of pocket.
9. Fill in any additional details that the prescriber feels are important for the review process, including comments, symptoms, or diagnoses.
10. Finally, the prescriber must sign and date the form. Ensure to include the office contact name and phone number for any follow-up that may be needed.
11. Once completed, save the changes, and consider printing or sharing the form with relevant parties.

Complete your forms online to streamline the prior authorization process.