Asking for an exception

We expect that the drugs on the Approved Drug List for your plan will meet all your prescription drug needs. However, if your doctor prescribes a drug that's not covered, you may request an exception. 

Here's the process for asking for an exception:

  1. Your doctor will fill out a drug authorization request form that explains why you need the non-formulary drug.
  2. Priority Health will let you and your doctor know, within 24 hours of receiving all information we need to make a decision, whether or not we approve the drug for you. If approved, the drug is covered at the highest applicable cost-sharing level after deductible, depending upon your pharmacy plan design.
  3. If you are not happy with the decision, you (the member) or an appointed representative have the right to appeal the request.