Once an exception status drug is approved, can the pharmacy bill Pharmacare for the cost of the medication?
Yes. Once approved, the exception status drug can be billed online to the appropriate Pharmacare Program. Usual deductible and copayment rules apply. Some exception status drugs are approved for a limited time. If you require the medication beyond the specified timeframe, your prescriber must re-apply for ongoing coverage. If you have received the drug while awaiting authorization and the request is eventually approved, you can usually be reimbursed. Coverage can be backdated up to three months to allow the pharmacy to bill the claim online and reimburse you. Alternatively, you can send your original receipt to the Pharmacare Programs office for reimbursement.
Related Questions
- If my physician files an Exception Request and it is approved by CVS Caremark for a Level I or Level II drug, how long is the exception valid?
- I understand the pharmacist can bill Pharmacare for certain exception status drugs without a request form or letter from the physician?
- What drug cost does Pharmacare pay?
