Common use of Formulary Exception Process Clause in Contracts

Formulary Exception Process. We have a formulary exception process that allows you to request coverage for a prescription drug that is not in our formulary. This process is available when (i) the requested prescription drug is NOT a generic equivalent of a formulary drug and your doctor determines that a formulary drug is not effective for you; or (ii) the requested non-formulary prescription drug has a generic equivalent and you have a clinical reason why you are unable to take the generic prescription drug (such as, you have had an adverse reaction to the generic medication). The process for obtaining an exception is described below. For a formulary exception where the requested prescription drug is NOT a generic equivalent of a formulary drug the prescribing provider may obtain a Medical Exception Form by visiting our Web site at XXXXXX.xxx or calling the Physician and Provider Service Center. Requests may be submitted in one of the following ways:  by fax: submit the form to Catamaran at 0-000-000-0000;  by phone: contact Catamaran at 0-000-000-0000; or  by mail: send the completed form to: Catamaran Prior Authorization

Formulary Exception Process. We have a formulary exception process that allows you to request coverage for a prescription drug that is not in our formulary. This process is available when (i) the requested prescription drug is NOT a generic equivalent of a formulary drug and your doctor determines that a formulary drug is not effective for you; or (ii) the requested non-formulary prescription drug has a generic equivalent and you have a clinical reason why you are unable to take the generic prescription drug (such as, you have had an adverse reaction to the generic medication). The process for obtaining an exception is described below. For a formulary exception where the requested prescription drug is NOT a generic equivalent of a formulary drug the prescribing provider may obtain a Medical Exception Form by visiting our Web site at XXXXXX.xxx or calling the Physician and Provider Service Center. Requests may be submitted in one of the following ways:  • by fax: submit the form to Catamaran at 0-000-000-0000;  • by phone: contact Catamaran at 0-000-000-0000; or  • by mail: send the completed form to: Catamaran Prior Authorization