
Pharmaceutical Exception Request Form BlueCross BlueShield of


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People also ask
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How do I get a Tier Exception approved CVS?
Tier Exception There should be documentation to show that the lower-cost sharing alternative drug(s) were not effective. To request a tier exception: Fax a Tier Exception Form to CVS Caremark at 1-888-487-9257. Call CVS Caremark at 1-800-294-5979.
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What is the difference between a formulary exception and a tier exception?
A type of Medicare prescription drug coverage determination. A formulary exception is a drug plan's decision to cover a drug that's not on its drug list or to waive a coverage rule. A tiering exception is a drug plan's decision to charge a lower amount for a drug that's on its non-preferred drug tier.
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What do tiers mean for formulary?
What is a tiered formulary? Drug tierType of drugs included Tier 1 Most generic drugs Tier 2 Most common brand name drugs Preferred brand name drugs Some high-cost generic drugs Tier 3 Non-preferred brand name drugs Tier 4 (Specialty Tier) Unique or very high-cost drugs
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What is pharmacy exception processing?
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. Through this administrative process, a plan can agree to cover medically necessary nonformulary drugs on a case-by-case basis.
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What does formulary exception mean?
A formulary exception should be requested to obtain a Part D drug that is not included on a plan sponsor's formulary, or to request to have a utilization management requirement waived (e.g., step therapy, prior authorization, quantity limit) for a formulary drug.
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What is a letter of formulary exception?
A formulary exception request letter may be able to help a patient gain access by outlining the reasons why a treatment is necessary to meet the medical needs of the patient.
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What is an exception request for medication?
An exception request is a type of coverage determination. An enrollee, an enrollee's prescriber, or an enrollee's representative may request a tiering exception or a formulary exception.
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What does formulary exclusion 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.
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