01
When to request
Use this workflow when your plan does not cover a drug your prescriber believes is medically necessary and covered alternatives are not appropriate.
Documents · Formulary desk
Formulary Exception Request
When a medically necessary prescription is not on your plan's formulary, you and your prescriber can request an exception. Walk through each step and attach supporting documents.
02
Timeline
Medicare plans must respond to standard exception requests within 72 hours. Keep filling through your pharmacy while the plan reviews your request.
03
What you'll need
Your plan name, the exact drug and strength, prescriber contact information, and clinical documentation explaining why alternatives won't work.
Before you begin
- Confirm the drug is not covered using our formulary lookup.
- Your prescriber may need to provide a statement of medical necessity.