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.
Medicaid Plans
We work with the Michigan Department of Health and Human Services (MDHHS), and other health plan partners, to determine what is covered under the Medicaid pharmacy benefit. The list of covered medications is called the Medicaid Health Plan Common Formulary. We strive to provide robust access to safe and effective therapy. However, if you feel that there are no appropriate options covered on our formulary, you may request a formulary exception by ePA, fax, or phone.
It is important to know that not all drugs can be covered by this Medicaid plan. When a drug is not covered on the State of Michigan’s Michigan Pharmaceutical Product List (MPPL), it will not be covered by this plan. Additionally, there are some Health Plan Carve Out drugs that are excluded from coverage by Priority Health, but may be covered by the Fee For Service Medicaid plan. More information regarding the members pharmacy benefit and coverage limitations can be found in the Member Handbook and Certificate of Coverage.
- Medicaid Certificate of Coverage and Member Handbook
- Healthy Michigan Plan Certificate of Coverage and Member Handbook
All other plans
Request an exception to our commercial formularies using the Pharmacy Drug Request Prior Authorization form.
Fax the form to Priority Health using the number on the form.