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
-
Go to the "prior auth/medical necessity for drugs" forms and print out the appropriate form. This link opens in a new browser window.
- Fax Priority Health the form and appropriate supporting documentation to the address given on the form.
- 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 (31KB PDF).
