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Requesting Non-Formulary Drugs

If you determine it necessary and clinically appropriate to prescribe an excluded or non-formulary drug:
  1. Go to the "prior auth/medical necessity for drugs" forms and print out the appropriate form. This link opens in a new browser window.
  2. Fax Priority Health the form and appropriate supporting documentation to the address given on the form.
  3. We will review the clinical reason(s) supporting the request and reply to you within 48 hours.


Last modified 06/26/06