How do I request an exception to the Gateway Health Plan Medicare Assured® formulary?
TOP You can ask Gateway Health Plan Medicare Assured® to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. • You can ask us to cover your drug even if it is not on our formulary. • You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Gateway Health Plan Medicare Assured® limit the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more. Generally, Gateway Health Plan Medicare Assured® will only approve your request for an exception if the alternative drugs included on the plan’s formulary or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you are requesting a formulary or utilization restriction ex
