To ensure swift approval, submit the following with your prior authorization request:
1. Completed Prior Authorization Form: Download the form directly from the Express Scripts website. Accurately fill out all sections, providing clear and legible information.
2. Patient Medical Records: Include relevant medical history detailing erectile dysfunction, including diagnoses, treatments attempted, and their effectiveness. Specific dates are important.
3. Physician’s Letter of Medical Necessity: This letter should clearly state the diagnosis, the reason Viagra is the appropriate treatment, and why alternative treatments have been deemed unsuitable. Include dosage and treatment duration.
4. Treatment Failure Documentation: If other treatments have been tried, provide detailed documentation confirming their inefficacy. This includes medication names, dosages, and duration of use.
Note: Faxing or uploading documents electronically is usually faster than mailing. Check Express Scripts’ website for their preferred submission method.
5. Insurance Information: Verify that all patient insurance details are correct and up-to-date on the form. This prevents delays.
Submitting all required documents in a clear and organized manner significantly increases the chances of prompt authorization approval.
