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Form 5613 Brand Over Generic Prior Authorization Request Form
What Is Form 5613?
This is a legal form that was released by the The Military Health System - TRICARE on August 10, 2011 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 5613?
A: Form 5613 is the Brand Over Generic Prior Authorization Request Form.
Q: What is the purpose of Form 5613?
A: The purpose of Form 5613 is to request authorization for a brand-name medication when a generic alternative is available.
Q: Who needs to fill out Form 5613?
A: Form 5613 needs to be filled out by healthcare providers or prescribers.
Q: What information is required on Form 5613?
A: Form 5613 requires information such as the patient's name, the generic medication that was tried, and the reason for the brand-name request.
Q: Is there a deadline for submitting Form 5613?
A: The deadline for submitting Form 5613 may vary depending on the healthcare provider or insurance company. It's best to check with them for specific deadlines.
Form Details:
- Released on August 10, 2011;
- The latest available edition released by the The Military Health System - TRICARE;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 5613 by clicking the link below or browse more documents and templates provided by the The Military Health System - Tricare.
