In some situations, your doctor may want to prescribe a drug for you that is not on the plan’s formulary. In other situations, you are already using a drug which the plan proposes to remove from the formulary.
If the doctor believes the drugs on the formulary are not medically appropriate for you, either you or your doctor can request an exception from the plan so that it will cover the drug the doctor wants to prescribe or the drug you are using.
Likewise, your doctor may prescribe a drug that costs more because it is under a more expensive cost-sharing tier than other drugs. If the doctor believes that the drugs covered under the less expensive cost sharing tier are not medically appropriate for you, either you or the doctor can request an exception from the plan so that it will enable you to get the drug at the lower cost.
1. Make the request
Your doctor will need to tell the plan why you need the drug prescribed.