Requesting Non-Formulary Drugs

If you determine it necessary and clinically appropriate to prescribe an excluded or non-formulary drug:

When the patient is a member of a commercial plan

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 within 48 hours.

When the patient is a member of a Priority Health Medicare plan

Request an exception to the Priority Health Medicare formulary using the federal government's Request for Medicare Prescription Drug Determination Form (237KB PDF).