To request approval for a non-formulary drug, your doctor needs to send in some additional information to ensure the medication meets the exception criteria. In general, these exceptions make sure that you need the medication, that other covered medications are not adequate for your needs, or that the drug or dose requested is medically necessary.
For fastest processing, ask your doctor to submit non-formulary medication requests online through CoverMyMeds.com, MHK Provider Portal (accessed by logging in to Blue e), or SureScripts.
The prescription must meet the non-formulary exception criteria to receive approval. All the information your provider needs and any forms your doctor must fill out and submit can be found on our Provider's Prior Authorization for Prescription Drugs page.
If your request for a non-formulary drug is approved, these cost levels, or "tiers," will apply:
- Essential Q formulary = Tier 5
- Essential QS formulary = Tier 4
- Essential C formulary = Tier 5