
Formulary Exception Request Form Independent Health


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People also ask
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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.
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What does a 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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Does Independent Health cover Ozempic for weight loss?
Some GLP-1 medications (e.g., Mounjaro®, Ozempic®, Rybelsus®, Trulicity® and Victoza®) are approved by the FDA for type 2 diabetes but not for weight loss. Therefore, these products are covered on Independent Health's formulary* only for the treatment of type 2 diabetes.
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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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What PBM does Independent Health use?
Independent Health uses PBD's services for its 4,000 employer groups and more than 360,000 members. PBD also manages the pharmacy benefit for 50 self-funded groups, with more than 119,000 members. PBD serves members in all 50 states.
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How to write a formulary exception?
I am writing to request a formulary exception for [INSERT PRODUCT] for my patient, [Patient's Name] who is currently a member of [name of health plan]. I have included additional information to support my decision to treat my patient with [INSERT PRODUCT].
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What is a formulary form?
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
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