Formulary Exception definition
Examples of Formulary Exception in a sentence
For appeals of a decision that a prescription drug is not covered because it is not on our formulary, please see the Formulary Exception Process in the Prescription Drug and Diabetic Equipment and Supplies section.
To request a Formulary Exception you or your provider must call or submit your request in writing to: Express Scripts, Inc.
Attn: Prior Authorization Mail Stop B401-03 ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇ St. Louis, MO 63134 Phone: ▇-▇▇▇-▇▇▇-▇▇▇▇ After your request for a Formulary Exception has been reviewed, you will receive written notification of our decision to approve or deny your request.
The non covered Prescription Drug benefits above may be covered if approved during the Formulary Exception Process.
If you are suffering from a health condition that may seriously jeopardize your health, life or ability to regain maximum function or if you are undergoing a current course of treatment using a non-Formulary Prescription Drug, you may request an expedited review of a Formulary Exception.
In these instances you, your Authorized Representative or your provider may submit a Formulary Exception Request following the prior Authorization process.
If your Formulary Exception Request is denied, you have the right to Appeal the decision.
How to Request an Expedited Formulary Exception Review You may request an expedited review if a delay could significantly increase the risk to your health or your ability to regain maximum function, or you are undergoing a current course of treatment with a drug not on our formulary.