California form aetna 2026

1. Click ‘Get Form’ to open the California Prescription Drug Prior Authorization or Step Therapy Exception Request Form in the editor.
2. Begin by filling out the 'Plan/Medical Group Name' and contact details, including fax and phone numbers. Ensure all information is accurate for efficient processing.
3. In the 'Patient Information' section, enter the patient's first name, last name, date of birth, address, and contact number. Select gender and provide height and weight measurements.
4. Complete the 'Insurance Information' fields by entering primary and secondary insurance names along with patient ID numbers.
5. Fill out the 'Prescriber Information' section with details about the prescribing physician, including their NPI number and contact information.
6. In the 'Medication / Medical and Dispensing Information' section, specify medication details such as name, dosage, frequency, and administration method.
7. Provide any required clinical information that supports the request in the designated area. Attach additional documentation if necessary.
8. Finally, ensure that you sign or electronically verify your attestation before submitting your completed form via fax or online through our platform.

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