Minnesota Uniform Formulary Exception Form
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People also ask
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How long does a formulary exception take?
– Once the exception is filed, the plan should provide a decision within 72 hours. If your doctor feels that you not having the medication could put you in serious harm, an “urgent” or expedited request can be filed, and a decision would be made by your health plan within 24 hours. -
What is a formulary exception form?
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. -
What is a medical or formulary exception?
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. -
How does a formulary exception work?
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. -
What is the drug formulary exception process?
A Formulary Exception Request Letteris a written request asking that the restriction placed on a specific medication be released as it is medically appropriate and necessary for the patient's treatment. -
What is a formulary exception and how are formulary exceptions handled?
A formulary exception is a type of coverage determination that is used when a medication is not included on a health plan's formulary (list of drugs) or is subject to an NDC block. -
What happens when a medication is not on the formulary?
If you need a drug that is not on your health plan's formulary, you must get your plan's approval or pay for the drug yourself. Your doctor should ask the plan for approval. In certain cases, a health plan may be required to cover a drug that is not on your plan's formulary. -
What does formulary override exception mean?
A formulary exception request is needed when the prescriber is requesting coverage for a non-formulary medication. Exception requests and prior authorization requests should be submitted using the same form – the Medication Coverage Request Form.
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