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How to fill out the CVS 91-13393a online
Filling out the CVS 91-13393a form can ensure that a patient receives a brand-name drug instead of a generic alternative. This guide will provide clear and comprehensive steps to assist you in completing the form accurately and efficiently.
Follow the steps to successfully complete the form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the patient information. Fill in the patient's name, date of birth, and plan participant ID number. Ensure this information is accurate to avoid delays.
- Input the prescriber information. Provide the prescriber's name, phone number, and fax number. This section is essential as incomplete information may delay processing.
- Complete the required details about the brand drug. Specify the brand drug name, strength, and dosage form that the patient requires.
- Describe the patient's diagnosis to provide context for the request for a brand-name drug.
- Answer the following questions regarding generic alternatives: List the generic alternatives that the patient has tried or considered. Provide evidence or reasoning that justifies the request for the brand-name drug, explaining why the generic alternatives are unsafe or ineffective.
- Finally, include any additional information pertinent to the patient's condition that supports the request for the brand-name drug.
- Ensure the prescriber signs and dates the form, certifying that all provided information is accurate and complete.
- Once the form is completed, you can save your changes, download, print, or share it for submission. Remember to fax the completed form to the CVS Caremark Appeals Department at the provided toll-free number.
Complete your CVS 91-13393a form online today for a seamless experience.
Requesting a tier exception on Caremark typically requires you to submit a form or contact customer support. You'll need to provide details such as your medication, dosage, and a letter of medical necessity from your doctor. The Caremark team aims to expedite the process, especially if you reference CVS 91-13393a for any specific instructions or assistance.