Request a formulary exception

You may request that we cover a non-formulary drug for a patient, or request an exception to requirements such as step therapy for drugs on our formularies.

Medicare Advantage plans

Request an exception to the Priority Health Medicare formulary using the federal government's Request for Medicare Prescription Drug Determination form.

All other plans

Request an exception to our commercial formularies or to the Medicaid/Healthy Michigan Plan formulary using the Non-covered Medication Prior Authorization form.

Fax the form to Priority Health using the number on the form.

We will review the clinical reason(s) supporting your request and a determination will be made within 14 days.