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COVERAGE EXCEPTION PRESCRIBER FAX FORM ONLY the prescriber may complete and fax this form. This form is for prospective concurrent and retrospective reviews. Please note medical records Please fax or mail this form to Blue Cross and Blue Shield of Montana c/o Prime Therapeutics LLC Clinical Review Department 1305 Corporate Center Drive Eagan Minnesota 55121 TOLL FREE Fax 877. Bcbsmt. com. Start saving time today by filling out this prior authorization form electronically. Visit covermymeds....

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Formulary information typically includes a list of medications covered by a health insurance plan.

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Health insurance providers are typically required to file formulary information.

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The purpose of formulary information is to inform consumers about which medications are covered by their insurance plan and any associated costs.

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Formulary information must include the names of covered medications, any restrictions or limitations on coverage, and cost-sharing details.

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