Medication Request Form

Your email was sent directly to the inbox of the AH Clinical Pharmacy Leadership Team. You will be contacted back via email and/or telephone by a member of the Clinical Pharmacy Team using the contact information that you provided. The contact will be designed to obtain the details and time sensitivity of your request.

The Clinical Pharmacy Team will collaborate with you as the requesting provider. The review and approval pathway will depend on the specific type of request, but approval is achieved through review by provider subject matter expert groups, physician clinical service lines, Ambulatory Care Clinical Advisory Group, and the Pharmacy & Therapeutics Committee.

Evaluations of new medications for formulary include review of clinical effectiveness, safety, and cost. Additionally, the review evaluates policies by payers, reimbursement specifics, availability of patient assistance programs and issues of access. The need for order sets, infusion protocols and interventions to enhance patient safety are also considered as part of a formulary evaluation.

The timeline is dependent on the nature and urgency of the request as well as the FDA approval status of the medication in question. Urgent patient need for FDA approved medications can be achieved more quickly and can include evaluation on a case-by-case basis. The normal turn around for an FDA approved non urgent request is 60-90 days. Medications that have not achieved FDA approval are a put on a more extended timeline to allow for effective use of resources and availability of needed information that is only available post approval.

Several steps must occur prior to administration of newly approved medications. The Clinical Pharmacy Team must determine availability for purchase, pricing, payer policies and administration specifics prior to administration. The usual process is 90-120 days. The urgency of patient care can prompt a case-by-case review or complete medication review with approval by the appropriate provider leadership authorization.

Because the infusion center cares for patients from a diverse group of providers and payers, choice of agents within a medication class is usually necessary. If there is not a medical reason or a payer preference to use an alternate agent, the AH Preferred agent should be considered. The benefit investigation process will determine which agent is covered by the patient’s insurance. If the patient’s payer directive is not the medication ordered by the provider, the Business Center will contact the ordering provider for an order for the preferred agent. Otherwise, the provider may need to contact the payer to appeal.