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DRUG FORMULARY EXCEPTION REQUEST FORM This form is to be used by members for the submission of information to request an exception to the St. Louis Graphic Arts Joint Health and Welfare Trust Fund

How to fill out drug formulary exception request

How to fill out a drug formulary exception request:

1. Obtain the necessary form: Start by obtaining the drug formulary exception request form from your health insurance provider. You may be able to download it from their website or request a physical copy.
2. Fill in your personal information: Begin by filling in your personal details such as your name, contact information, and insurance policy number. Make sure to double-check for any errors or missing information.
3. Provide information about the prescribed medication: Indicate the name and dosage of the medication for which you are requesting an exception. Include the reason why this particular medication is necessary for your treatment and any supporting documentation such as medical records or a doctor's note.
4. Explain the medical necessity: In a separate section specifically addressing medical necessity, elaborate on why the requested medication is essential for your health and well-being. Provide details about previous treatments you have tried, any adverse reactions or side effects experienced with alternative medications, and how the requested medication is expected to improve your condition.
5. Attach supporting documentation: If applicable, include any supporting documentation that strengthens your case for the exception request. This may include letters from healthcare professionals, medical records, test results, or research articles.
6. Review and submit the request: Take the time to carefully review the completed form, ensuring that all the required fields are filled out accurately. If necessary, make copies of the form and supporting documents for your records. Once you are confident that everything is in order, submit the request to your health insurance provider according to their specified method (e.g., online submission, mail, or fax).

Who needs a drug formulary exception request:

1. Patients prescribed medications not covered by their insurance: If you have been prescribed a medication that is not included in your health insurance's drug formulary, you may need to submit a drug formulary exception request to seek coverage or a lower cost-sharing for the medication.
2. Patients who have tried and failed alternative medications: If you have already attempted alternative medications for your condition but found them ineffective or causing adverse reactions, you may qualify for a drug formulary exception request. This applies if the requested medication is deemed medically necessary for your treatment.
3. Patients requiring medications not on the insurance's preferred drug list: Health insurance providers often have a preferred drug list, also known as a formulary, that determines the medications they cover. If the medication your doctor has prescribed is not on this list, you may need to submit a drug formulary exception request to obtain coverage for it.

Overall, anyone who is facing barriers in accessing a prescribed medication due to insurance coverage limitations should consider submitting a drug formulary exception request. This will provide an opportunity to present a compelling case for why the requested medication is necessary for their health and explore possible alternatives for coverage or lower cost-sharing.

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