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:
- Your doctor will fill out a drug authorization request form that explains why you need the non-formulary drug.
- 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 you are not happy with the decision, you (the member) or an appointed representative have the right to appeal the request.