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The document is a Prior Authorization Form for Topical Testosterone, outlining the necessary patient and prescriber information, medication requests, and clinical assessments required to determine eligibility for coverage. It includes specific questions regarding the patient's diagnosis, prior treatments, and intended use of the medication. The form emphasizes that additional information may be needed based on individual insurance plans and provides contact details for urgent requests.

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How do I get a Tier Exception approved CVS?

Tier Exception There should be documentation to show that the lower-cost sharing alternative drug(s) were not effective. To request a tier exception: Fax a Tier Exception Form to CVS Caremark at 1-888-487-9257. Call CVS Caremark at 1-800-294-5979.

What does tier mean in medical billing?

Under a healthcare plan, the list of covered prescription drugs is called a formulary. The formulary is usually divided into tiers or levels of coverage based on the type or usage of the medication. Each tier will have a defined out-of-pocket cost that the patient must pay before receiving the drug.

What does tier exception mean?

With Express Scripts, Tier 1 will include all generic drugs, Tier 2 will include all preferred brand-name drugs and Tier 3 will include all nonpreferred brand-name drugs. Its important to note that some medicines may move from one tier (copayment/co-insurance level) to another.

How long does a tier exception take?

Once submitted, your doctor should hear back about your plans decision within a couple days after the request. If approved, your medication will be covered at cost-sharing that applies in the lower tier.

How to get a tier exception approved?

Your plan must give you a decision within 72 hours of receiving the request. You can request a fast (expedited) appeal if you or your doctor feel that your health could be seriously harmed by waiting the standard timeline for appeal decisions.

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What is a tier exemption?

A tiering exception request is a way to request lower cost-sharing. For tiering exception requests, you or your doctor must show that drugs for treatment of your condition that are on lower tiers are ineffective or dangerous for you.

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