Get Express Scripts And Prior Authorization Form

Completing the Express Scripts And Prior Authorization Form online is an important process for ensuring your medication is approved in a timely manner. This guide provides clear instructions to help you navigate each section of the form effectively.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by filling out the personal information section, including the last name, first name, home phone, and home address. Make sure this information is accurate to avoid any delays.
3. Next, provide the prescriber’s name, office phone, work phone, city, state, and ZIP code. This section is crucial for ensuring that your healthcare provider is contacted if further information is needed.
4. Enter the SCAN ID number and date of birth of the individual requiring the medication. This helps to verify eligibility.
5. Specify the specialty and office fax number of the prescriber. You may also include the estimated start date for the medication.
6. If there is a shipping address different from the home address, please include that information here.
7. Fill in the medication details including medication name, diagnosis, dosing instructions (Sig), quantity, and refills. Accurate medication details are essential for the authorization process.
8. If applicable, provide information regarding secondary or supplemental insurance, including company details, name of insured, ID number, and group number.
9. Indicate if the diagnosis is related to the specific treatment of relapsing forms of Multiple Sclerosis. This is critical for approval.
10. Include any other comments, diagnoses, symptoms, lab values, or relevant information that might assist in the review of your request.
11. Finally, ensure the prescriber signs the form and includes their NPI/DEA number and the date. An unsigned form may delay processing.
12. Review all the information to ensure completeness. Failure to complete this form in its entirety may result in delayed processing.
13. Once all sections are completed, users can save changes, download, print, or share the form as needed.

Start filling out your documents online to ensure a smooth and timely authorization process.