Caremark brand penalty exception form 2026

1. Click ‘Get Form’ to open the caremark brand penalty exception form in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. This information is crucial for identifying the individual requesting the exception.
3. Next, fill in the prescriber’s details, including their name, phone number, and fax number. Accurate contact information ensures smooth communication with CVS/Caremark.
4. Specify the brand-name drug requested along with its strength and dosage form. Additionally, provide a diagnosis that justifies this request.
5. List any generic alternatives that have been tried or considered by the patient, including dates. This section helps demonstrate prior attempts at using generic options.
6. Provide evidence regarding why the generic alternatives are unsafe or ineffective. Include any known interactions with other medications currently taken by the patient.
7. Add any additional pertinent information related to the patient's condition and request in the final section before signing.
8. Once completed, ensure all supporting documentation is attached and fax it to CVS Caremark Appeals Department at 1-866-689-3092.

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