Get 18552400536

Filling out the 18552400536 is an important step in securing prior authorization for medication coverage. This guide will walk you through each component of the form, ensuring that you provide all necessary information accurately.

Follow the steps to complete the form efficiently.

1. Click the ‘Get Form’ button to access the form and open it in a digital editor.
2. Begin by filling out the patient information section. Include the patient’s full name, ID, group number, date of birth, and phone number.
3. Next, provide details about the prescribing physician. Include their name, phone number, fax, and address, including city, state, and zip code.
4. In the diagnosis section, enter the specific condition for which the medication is being requested and include the corresponding ICD code.
5. Choose the drug name from the list provided. Options may include HFA, HFA, or HFA. Indicate the quantity, route of administration, frequency, strength, and expected length of therapy.
6. Respond to each question presented in the comments section. Circle the appropriate answer for questions related to FDA-approved indications and any prior treatment responses.
7. If applicable, document any reasons for not trying formulary alternatives, including drug names, trial years, and reasons for failure.
8. Ensure that all information provided is accurate. Once completed, review the form one last time for any errors or omissions.
9. Finally, sign and date the form. Submit the completed form by faxing it to CVS/Caremark at 1-888-836-0730.
10. After submitting, keep a copy of the form for your records. You may also download or share the form as needed.

Start completing your documents online today for a smoother authorization process.