Get Silverscript Non-formulary Exception Form 2012
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How to fill out the SilverScript Non-Formulary Exception Form online
The SilverScript Non-Formulary Exception Form is essential for users who need coverage for medications not listed on the formulary. This guide provides clear, step-by-step instructions on how to efficiently complete the form online, ensuring a smooth process for submitting your request.
Follow the steps to fill out the SilverScript Non-Formulary Exception Form online
- Press the ‘Get Form’ button to access the SilverScript Non-Formulary Exception Form and open it in your document editor.
- Begin filling in the patient information section. Include the patient's name, member ID, Medicare ID, date of birth, sex, and address details.
- Next, provide the prescriber and pharmacy information, including the prescriber's name, specialty, DEA, NPI, and the address of the pharmacy.
- In the drug information section, specify the drug name, whether it is brand or generic, the strength, dosage form, quantity per 30 days, and if it is newly prescribed or a refill.
- Fill in the directions for use, diagnosis, and ICD-9 code if applicable.
- If an expedited review is required, ensure to indicate this at the top of the form and certify the necessity.
- Provide medical justification for the non-formulary drug exception request, explaining why formulary alternatives are not suitable.
- Ensure the prescriber signs and dates the form to attest the accuracy of the information provided.
- Once all sections are completed, review the form for accuracy. Users can then save the changes, download, or print the form for submission.
Start filling out your SilverScript Non-Formulary Exception Form online today for timely processing.
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Requesting a formulary exception for Medicare can be streamlined using the SilverScript Non-Formulary Exception Form. Begin by filling out this form with the required information about the medication and your medical situation. Your healthcare provider may need to provide additional information to justify the need for the non-formulary drug. Be sure to submit the form along with any supporting documents to facilitate the approval process.
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