What are Coverage Exceptions?
Download the Prior Authorization form. There are several types of exceptions to the coverage rules that are defined in a member’s contract: • Even if a drug is not on our formulary, your physician may request that we cover it. • Some drugs are considered “contract exclusions” meaning as per your contract, the drug is not covered. • If a drug has a quantity limit, your physician may ask us to override the limit and cover a larger quantity.
