Get the free FORMULARY EXCEPTION

This form is used by prescribers to request an exception for a formulary medication. It includes patient and physician information, diagnosis, medication requested, treatment history, and justification

How to fill out formulary exception

How to fill out FORMULARY EXCEPTION

1. Obtain the FORMULARY EXCEPTION request form from your healthcare provider or insurance company.
2. Fill in your personal details, including name, date of birth, and insurance information.
3. Provide details about the medication for which you are requesting the exception, including the name and dosage.
4. Explain the medical necessity for the medication and why alternatives are not suitable.
5. Attach any supporting documents, such as medical records or a letter from your doctor.
6. Review the form for accuracy and completeness before submitting.
7. Submit the form according to the instructions provided, either online, by mail, or by fax.

Who needs FORMULARY EXCEPTION?

1. Patients who require a specific medication not listed on their insurance formulary.
2. Individuals who have exhausted all other treatment options available on the formulary.
3. Those with chronic conditions needing specialized medications.

People Also Ask about

What do formulary exclusions mean?

Formulary exclusions are drugs that a PBM chooses not to be included in coverage. Usually, a PBM will contract with multiple insurance providers to manage their prescription benefits. A provider can choose not to follow their PBM's formulary exclusion list if they wish to cover a drug.

What does it mean to not be on the formulary?

A non-formulary drug refers to any medication that isn't included on your health insurance plan's formulary. These drugs are oftentimes not covered meaning that you will likely have to pay the full price unless you take steps to request coverage.

What is the meaning of formulary?

A formulary is a list of all the drugs covered by a health insurance plan. Health plans have different formularies, which means that a particular drug might be covered by one plan in your area, but not by another.

What is a formulary exception?

Under a closed formulary pharmacy benefit, the health plan or payer provides coverage only for those drugs listed on the formulary. An exception procedure can be used by prescribers and patients to request coverage for drugs that are not included on a plan's drug formulary.

For pdfFiller’s FAQs

What is FORMULARY EXCEPTION?

A formulary exception is a request to allow a patient to receive a medication that is not included on their insurance plan's formulary list, usually due to specific medical necessity.

Who is required to file FORMULARY EXCEPTION?

Healthcare providers, such as physicians, or sometimes the patients themselves are required to file a formulary exception for coverage of non-formulary medications.

How to fill out FORMULARY EXCEPTION?

To fill out a formulary exception, complete the specific form provided by the insurance company, providing detailed information about the patient's condition, the medication requested, and reasons for the exception.

What is the purpose of FORMULARY EXCEPTION?

The purpose of a formulary exception is to ensure that patients can access necessary medications that are not typically covered under their insurance plan's formulary, based on their individual health needs.

What information must be reported on FORMULARY EXCEPTION?

Information that must be reported includes the patient's demographic details, the prescribing physician's information, the medication name, dosages, diagnosis, and the rationale for why the non-formulary medication is necessary.