Fill Out Your Generic Request Form

Completing the Generic Request form requires meticulous attention to detail. Start with a common mistake: failing to provide complete patient and physician information. Each field marked with asterisks needs to be filled out accurately. Missing or incorrect entries can delay the processing of the request, potentially impacting patient care.

Another frequent error is poor legibility. It is crucial to print clearly. If the information cannot be read, it can lead to misunderstandings or, worse, a rejection of the request. Always use a pen with black or blue ink, as light colors may not photocopy well and could create further complications.

Some individuals neglect to check the patient's previous use of the generic product. It is vital to establish whether the patient has tried the alternative before proceeding. Not answering this question can lead to unnecessary back-and-forth communication, slowing down the approval process.

Equally important is the failure to document significant adverse reactions accurately. If a patient has had an adverse reaction to the generic, it must be noted explicitly. Skipping this step can result in the prescriber’s justification lacking the necessary support.

Inadequate explanations for why the A-rated generic cannot be used also pose an issue. Generic Request forms often face scrutiny due to insufficient clinical justification. It is expected that prescribers detail why a brand-name drug is more suitable, based on the specific circumstances of the patient’s health.

Submitting the form without a signature is a mistake one should not make. The prescriber’s signature and date serve as a validation of the provided information. An unsigned form is incomplete and will inevitably lead to delays.

Moreover, not verifying the contact details for the office is a common lapse. Ensure that the phone number and fax number are correct and functional. Clear lines of communication are essential when the pharmacy or insurance has questions about the request.

Patients often overlook the mailing process. Remember to check that the completed form is attached to the prescription before sending it out. Failure to do so may mean the request gets separated from the medication, leading to miscommunication.

Not providing an appropriate fax number or e-mail can also result in complications. If you're sending electronically, confirm that the email address is correct. A small typo in an email can send important documentation into the void, resulting in delays.

Lastly, keeping outdated information or using old forms can lead to confusion and rejection. Always ensure you are using the most current version of the form, which incorporates changes to policies or guidelines that could influence the approval process.

When submitting a Generic Request form, several other documents may accompany it to ensure the process is thorough and all necessary information is provided. Each of these forms plays a unique role in supporting the request for prior authorization or clarifying patient needs.

• Patient Medical History Form: This document outlines the patient’s medical background and any previous medications taken. It helps the prescriber justify the need for a brand name over a generic drug based on the patient's history.
• Prescriber Letter of Medical Necessity: A letter penned by the prescriber explaining why a specific brand name medication is necessary for the patient's treatment. This letter typically includes details about adverse reactions to generics or unique patient circumstances.
• Pharmacy Benefit Management Form: Often required by insurance companies, this form documents the patient's insurance coverage and any previous claims about medications. It ensures that all billing procedures align with the patient's pharmacy benefits.
• Adverse Reaction Report: If the patient experienced side effects from a generic medication, this report details those reactions. It serves to reinforce the need for a brand name alternative, providing evidence to support the request.
• Prior Authorization Tracking Form: This tracking form helps manage the authorization process. It includes dates, contact information, and any communications between the provider and the insurance company, which ensures transparency and accountability throughout the process.

Submitting the Generic Request form alongside these documents can facilitate a smoother approval process. By providing detailed information, you strengthen the case for the necessary medication, which can significantly impact patient care.

• Prior Authorization Request Form - Similar in purpose, this document is submitted to obtain approval before a medication can be filled. Both forms require completion by the prescriber and focus on justifying the necessity of a brand name over a generic.
• Medical Necessity Form - This form supports the need for specific treatment and may require similar patient and physician information. It allows for documentation of the medical justification for choosing one medication over another, aligning with the goals of the Generic Request form.
• Prescription Prior Authorization Form - This document serves to formally request prior authorization for prescription drugs. Like the Generic Request form, it necessitates detailed information about the patient, prescriber, and specific medication involved, and explains the reason for the choice of medication.
• Drug Exception Request - This document is comparable as it seeks an exception for a patient to receive a brand medication when generics are typically prescribed. Both forms capture clinical information to justify this request and require a prescriber’s signature.
• Specialty Pharmacy Request Form - It requests approval for specialized drugs, akin to exceptions in the Generic Request form. Each form requires thorough details, including the patient’s history with other medications.
• Out-of-Network Authorization Request Form - This document seeks permission to obtain coverage for medications from out-of-network providers. Its requirement for explicit rationale mimics the need for justification in the Generic Request form.
• Formulary Exception Request Form - Patients may use this form to request coverage for medications not included on the formulary. Similar to the Generic Request form, it requires a prescriber’s input on why a non-formulary item is necessary.
• Claim Reconsideration Form - Used to appeal an unsuccessful claim for medication coverage, this document shares the need for detailed explanations and justifications that align with the patient’s treatment plan, much like the Generic Request form.

When filling out the Generic Request form, there are important guidelines to follow to ensure that the process goes smoothly. Both patients and prescribers play a key role in this process. Below are some helpful do's and don'ts.

• Do ensure that all patient and physician information is completed accurately and clearly. Use print letters to avoid any confusion.
• Do state specifically which medication is being prescribed. This helps avoid any potential misunderstandings or delays.
• Do provide detailed explanations in the sections regarding adverse reactions or clinical justifications. Clear explanations are crucial for approval.
• Do check the form for completeness before submitting it. Missing information can hinder the process.

• Don't leave any sections blank. Incomplete forms may be returned or delayed.
• Don't use ambiguous language when detailing the patient’s experience or needs. Be as specific as possible.
• Don't neglect to sign and date the form. An unsigned form cannot be processed.
• Don't forget to verify that you are mailing the form to the correct address or faxing it to the right number. Double-check this information!

• Misconception 1: The Generic Request form is only for patients who cannot tolerate generic medications.

This is not entirely accurate. The form is meant for any patient who requires a brand-name drug instead of a generic, regardless of whether they have experienced intolerance.

• Misconception 2: Submitting the form guarantees approval for the brand-name medication.

Approval is not guaranteed. The prescriber must provide adequate clinical justification for the brand-name medication.

• Misconception 3: The process is the same for all medications.

Different medications may have varying requirements for approval, depending on their classifications and equivalences determined by regulatory bodies.

• Misconception 4: Patients do not need to be involved in the submission process.

Patients may need to attach the completed form to their prescription and send it to the designated address. Their involvement is important to ensure timely processing.

• Misconception 5: All generic medications require this form for brand-name alternatives.

This form is specifically for cases where clinical justification is necessary. Not all situations require its use.

• Misconception 6: The prescriber signature is optional.

This is incorrect. The prescriber must sign and date the form as an affirmation of the provided information's accuracy and completeness.

• Misconception 7: Only the prescriber can submit the form.

While the prescriber completes the form, patients may also submit it, either by mailing or emailing, as specified in the instructions.

• Misconception 8: The form must be mailed; faxing is not an option.

Faxing the completed form is indeed an option to expedite processing, offering flexibility for prescribers.

Utilizing the Generic Request Form involves several important steps and considerations. Here are ten key takeaways to keep in mind when filling it out and using it effectively:

• The form must be completed and signed by the prescriber.
• It is specifically for prescriptions to be filled through the Department of Defense (DoD) TRICARE pharmacy program.
• Express Scripts operates as the TRICARE pharmacy contractor for the DoD.
• Providers can call 1-866-684-4488 or fax the completed form to 1-866-684-4477 for inquiries or assistance.
• Patients should attach the completed form to their prescription, which can be mailed to Express Scripts at P.O. Box 52150, Phoenix, AZ 85072-9954.
• Alternatively, patients have the option to email the form to TpharmPA@express-scripts.com.
• When completing the form, all patient and physician information should be printed clearly.
• Ensure that you provide the patient's name, sponsor ID, phone number, and date of birth accurately.
• Identify the medication being prescribed in the designated section of the form.
• Clinical justification is required if the prescriber determines that a brand-name drug is necessary instead of the A-rated generic alternative.

Following these key points will help streamline the process and ensure that all necessary information is included.