Blank Express Scripts Template

What is the Express Scripts form used for?

The Express Scripts form is specifically designed for prescribers to submit fax prescriptions to Express Scripts. It allows medical professionals to order medications for their patients efficiently. Proper completion of the form ensures that prescriptions are processed quickly and accurately.

Who can submit the Express Scripts fax form?

Only prescribers' offices are authorized to submit the fax prescriptions using the Express Scripts form. This ensures that prescriptions are handled by qualified individuals who can verify the medical necessity and appropriateness of the medication prescribed.

Can controlled substances be faxed using this form?

No, prescriptions for Schedule II controlled substances (CII prescriptions) cannot be faxed. This regulation is consistent across many jurisdictions to ensure appropriate controls and measures for handling prescription medications. Prescribers must provide these prescriptions in person.

What information is required on the Express Scripts form?

The form requires detailed information including the prescriber’s name, DEA or NPI number, contact information, and patient details such as name, date of birth, and address. Additionally, specific drug information such as the drug name, strength, quantity, directions for use, and whether the brand name is necessary should be filled out.

How long does it take for a prescription to be processed?

Once the fax is received, it can take up to 72 hours for the prescription to be entered into the Express Scripts system. It is important not to resend or call in the prescription during this time, as it may cause delays in processing.

Is it necessary to call the Service Center after sending a fax?

No, it is not necessary to call the Service Center after submitting a fax. Calling may inadvertently slow down the processing of the prescription. The system is designed to handle incoming faxes efficiently.

What should I write if a brand name drug is necessary?

If a brand name drug is necessary, the prescriber must handwrite "BRAND NECESSARY" or "BRAND MEDICALLY NECESSARY" on the form. This specific instruction allows the pharmacy to dispense the brand name product as prescribed.

What confidentiality measures are in place for transmitted information?

The information contained in the Express Scripts form is considered confidential health information. It is intended solely for the recipient named on the form. Recipients must not disclose this information to any other parties unless required by law. If a sender receives this information in error, they must notify the sender and arrange for its return or destruction.

1. Missing Information: It is crucial to complete every field on the form. Any omission, such as the prescriber's name, DEA or NPI number, or patient’s details, might lead to delays or rejection of the prescription.

2. Incorrect Prescription Types: Some people mistakenly assume they can fax prescriptions for controlled substances. Remember, CII prescriptions cannot be faxed under any circumstance, which can lead to costly errors.

3. Handwriting Issues: When it comes to indicating that a brand name product is required, clarity is key. If the prescriber’s handwriting is unclear or indistinct, the request may be misunderstood, resulting in the wrong medication being dispensed.

4. Failure to Use a New Form for Each Patient: It's essential to remember that you must use a separate form for every patient. Utilizing one form for multiple patients can create confusion and processing delays.

5. Submission without Confirmation: After faxing the order, not confirming receipt can lead to anxiety and unanswered questions about whether the prescription was processed. Always follow up if possible.

6. Ignoring the 72-Hour Processing Window: Some individuals resubmit prescriptions too quickly, not allowing the necessary time for processing. This can inadvertently complicate and delay the fulfillment of the order.

When using the Express Scripts form for submitting prescriptions, several other forms and documents may accompany it to facilitate the process. Each of these documents plays a specific role in ensuring smooth communication and compliance with prescription guidelines. Here's a brief overview of commonly used forms.

• Patient Registration Form: This document collects essential information about the patient, such as contact details, insurance information, and medical history. It helps streamline the treatment process and ensures that the pharmacy has up-to-date patient information.
• Prescription Drug Order Form: This is the official document used to write prescriptions. It contains detailed instructions for the medication prescribed, including dosages and refill information. It must be completed by a licensed healthcare provider.
• Prior Authorization Form: A crucial document for certain medications that require approval from an insurance company before being dispensed. It typically requires additional details about the patient’s condition and treatment history.
• Insurance Claim Form: This form is submitted to the insurance company to seek reimbursement for the cost of a medication. It includes details about the patient, the medication dispensed, and the associated costs.
• Medication Therapy Management (MTM) Form: Used by pharmacists to document medication reviews and patient consultations. This ensures patients are aware of their medications and any potential interactions, enhancing safety and efficacy.
• Consent for Release of Information: This document gives permission for healthcare providers to share patient information with pharmacies and insurance companies. It’s important for compliance with privacy laws.
• Medication Administration Record (MAR): This record tracks the administration of medications to a patient, documenting what was given, when, and by whom. It is crucial for maintaining accurate medical records.
• Refill Authorization Request Form: If a patient needs to refill their prescription, this form allows them to request authorization from the prescribing healthcare provider. It ensures that refills are managed appropriately.

These documents, when used alongside the Express Scripts form, help ensure that prescriptions are filled accurately and efficiently while adhering to legal and health regulations. Understanding each form's purpose can greatly aid healthcare providers and patients in navigating the prescription process.

The Express Scripts form bears a resemblance to the medication prior authorization forms often used by healthcare providers and insurance companies. Like the Express Scripts order form, these prior authorization forms require detailed information about the patient, prescribed medication, and the prescriber. They are critical in ensuring the prescribed medication is covered by a patient's insurance plan before it can be dispensed. Precision in filling out these forms speeds the approval process and helps avoid delays in treatment, showcasing the importance of clear communication between healthcare providers and insurance companies.

Similarly, the prescription drug order form serves as a foundational document in the prescription process, akin to the Express Scripts form. This document includes all necessary details about the patient, medication, dosage, and prescriber information. Just as the Express Scripts form is specifically designed for fax submissions to a pharmacy, the prescription drug order form consolidates required information for the pharmacy to accurately fill the prescription. Ensuring that all relevant fields are completed assists in maintaining accuracy in the medication dispensing process.

The controlled substance prescription form is another document that parallels the Express Scripts form, especially when it comes to medications that require strict regulation due to their potential for abuse. While the Express Scripts form highlights that certain prescriptions cannot be faxed, the controlled substance form must adhere to similar stringent regulations. Both forms need meticulous attention to detail, as errors can lead to complications or delays in patient care.

A medication refill request form often complements the Express Scripts order form by facilitating ongoing patient care. When patients require refills on their medications, this document allows for the efficient communication between the pharmacy and the prescriber’s office. Much like the Express Scripts order form, refill requests need accurate patient and medication information to ensure timely processing and avoid interruptions in therapy.

Another document that shares similarities is the electronic prescription (eRx) form used in various healthcare settings. The eRx form allows prescribers to send prescriptions directly to pharmacies through a digital platform. While the Express Scripts form is fax-based, eRx provides a modern alternative that reduces errors and improves efficiency. Both forms emphasize the importance of complete and accurate information to ensure safe and effective medication delivery.

Lastly, patient consent forms also align with the structure of the Express Scripts form in that they require specific patient information and can contain sensitive health information. Just as the Express Scripts form indicates confidentiality and limits disclosure, patient consent forms protect both the patient's rights and the healthcare provider’s obligations concerning patient privacy. Both forms highlight the importance of understanding and adhering to privacy regulations and patient consent in the healthcare system.

When filling out the Express Scripts form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are some do's and don'ts to consider:

• Do fill in all required fields completely.
• Do ensure that the prescriber's office submits the fax prescription.
• Do write 'BRAND NECESSARY' or 'BRAND MEDICALLY NECESSARY' to ensure brand name products are dispensed.
• Do use this form for each patient’s order separately.
• Don't fax prescriptions for Schedule II (CII) drugs.
• Don't resend the prescription if it has already been submitted.
• Don't call the Service Center to check on the status of a faxed prescription.
• Don't share the contents of the fax with unauthorized parties as the information is confidential.

Understanding the Express Scripts form is essential for ensuring timely and accurate prescription processing. However, several misconceptions plague users of this form. Below are common misunderstandings along with clarifications.

• It is necessary to resend the prescription if there's a delay. Some believe that if the prescription isn't processed quickly, they should resend it. In reality, resending can complicate the process and create further delays in fulfillment.
• Anyone can fax prescriptions to Express Scripts. A common myth is that anyone can send prescription orders. However, only a prescriber's office is authorized to submit fax prescriptions.
• CII prescriptions can be faxed. Many individuals mistakenly think that all types of prescriptions, including CII, can be faxed. In fact, controlled substances classified as CII cannot be faxed at all.
• All information on the form is optional. Some users think that they can skip certain fields if they don't apply. This is incorrect; it is crucial to fill in all required information to avoid processing issues.
• A printed signature is acceptable. There is a belief that a printed signature will suffice on the form. However, it is essential for the prescriber to provide a handwritten signature to validate the prescription.
• Using different forms for each patient is allowed. Some might think they can use varying forms for different patients. Instead, the Express Scripts form is specifically designed to be used for each individual patient to streamline processing.
• Brand name products can be prescribed without specific notation. There’s a misconception that prescribers can request brand name medications generally. In reality, they must handwrite 'BRAND NECESSARY' or 'BRAND MEDICALLY NECESSARY' for brand products to be dispensed.
• Faxing the form guarantees immediate fulfillment. Lastly, people often expect that submitting the form instantly fulfills their prescription needs. While the submission process is crucial, it can still take up to 72 hours for the prescription to be entered into the system.

Being aware of these misconceptions can help ensure a smoother experience when using the Express Scripts form. Proper understanding leads to fewer delays and better service for patients.

• The Express Scripts form must be completed accurately and fully to ensure efficient processing.
• Fax orders to Express Scripts at the specified number: 800-396-2171.
• It may take up to 72 hours for a prescription to be entered into the system after faxing.
• Do not resend the prescription or call the Service Center; this can delay your patient's order.
• CII prescriptions cannot be faxed; only non-CII prescriptions can be submitted via fax.
• For brand name products, the prescriber must handwrite 'BRAND NECESSARY' or 'BRAND MEDICALLY NECESSARY' on the form.
• Use one form per patient to ensure clarity and prevent mistakes.