Formulary Exception Request (Non-Medicare)

You may request an exception to your prescription medication coverage for drugs that are not included on your prescription drug list. Please note the following restrictions; a formulary exception request is for non-covered self-administered drugs only. A formulary exception request is different from a prior authorization request which is required for certain covered drugs.

To make a request for an exception to your prescription medication coverage, you can complete one of the following options:

• Call the number on the back of your ID card
• Fill out the formulary exception request by clicking here.

We will contact your prescribing physician for a statement to support the request for a formulary exception.

Generally we make our decision within 7 business days of receiving your prescribing physician's supporting statement. We will send a letter to you and your prescribing physician once a decision has been made.

If you are in Medicare Part D plans BlueRx or Blue Advantage, please call the number on the back of your member identification card for assistance.