Formulary Exception definition

Formulary Exception means BCBSAZ and/or the PBM has authorized coverage of a Non- Formulary Medication for a member. BCBSAZ and/or the PBM decide whether to authorize Formulary Exceptions for coverage of Non-Formulary Medications.
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Examples of Formulary Exception in a sentence

  • For appeals of a decision that a prescription drug is not covered because it is not on our formulary, please see the Formulary Exception Process in the Prescription Drug and Diabetic Equipment and Supplies section.

  • Standard Review of a Formulary Exception – We will make a decision and notify the Insured Person, his or her designee, and the prescribing Health Care Professional no later than 72 hours after Our receipt of the Insured Person’s request.

  • Standard Review of a Formulary Exception – We will make a decision and notify You or Your Authorized Representative and the prescribing Health Care Professional no later than 72 hours after Our receipt of the Member’s request.

  • Expedited Review of a Formulary Exception – If the Insured Person is suffering from a health condition that may seriously jeopardize his or her health, life, ability to regain maximum function, or if the Insured Person is undergoing a current course of Treatment using a Non-Formulary Prescription Drug, he or she may request an expedited review of a Formulary exception.

  • Expedited Review of a Formulary Exception – If You are suffering from a health condition that may seriously jeopardize Your health, life or ability to regain maximum function or if You are undergoing a current course of Treatment using a Non-Formulary Prescription Drug, You may request an expedited review of a Formulary exception.

  • Standard Review of a Formulary Exception – We will make a decision and notify You or Your designee and the prescribing Health Care Professional no later than 72 hours after Our receipt of the Member’s request.

  • Expedited Review of Formulary Exception – If You are suffering from a health condition that may seriously jeopardize Your health, life or ability to regain maximum function or if You are undergoing a current course of Treatment using a Non-Formulary Prescription Drug, You may request an expedited review of a Formulary exception.

  • The non covered Prescription Drug benefits above may be covered if approved during the Formulary Exception Process.

  • Expedited Review of a Formulary Exception – If the Insured Person is suffering from a health condition that may seriously jeopardize his or her health, life, ability to regain maximum function, or if the Insured Person is undergoing a current course ofTreatment using a Non-Formulary Prescription Drug, he or she may request an expedited review of a Formulary exception.

  • Beneficiaries who have a coverage determination (prior authorization or Formulary Exception) denied, will receive a denial letter indicating their drug is not a Part D drug.

Related to Formulary Exception

  • Seller 401(k) Plan shall have the meaning set forth in Section 6.01(i).

  • Bankruptcy Exceptions means limitations on, or exceptions to, the enforceability of an agreement against a Person due to applicable bankruptcy, insolvency, reorganization, moratorium or similar laws affecting the enforcement of creditors’ rights generally or the application of general equitable principles, regardless of whether such enforceability is considered in a proceeding at law or in equity.

  • Enforceability Exceptions has the meaning set forth in Section 3.2.

  • Bankruptcy Exception means, in respect of any agreement, contract, commitment or obligation, any limitation thereon imposed by any bankruptcy, insolvency, fraudulent conveyance, reorganization, receivership, moratorium or similar Law affecting creditors’ rights and remedies generally and, with respect to the enforceability of any agreement, contract, commitment or obligation, by general principles of equity, including principles of commercial reasonableness, good faith and fair dealing, regardless of whether enforcement is sought in a proceeding at Law or in equity.

  • Enforceability Exception has the meaning set forth in Section 3.05.

  • Buyer 401(k) Plan has the meaning set forth in Section 6.01(h).

  • Bankruptcy and Equity Exception means that this Agreement is, when executed and delivered by such member(s) of the Seller Group and assuming the due authorization, execution and delivery hereof by the members of the Purchaser Group that are (or are contemplated to be) party hereto, will be, legal, valid and binding obligations of such members of the Seller Group enforceable in accordance with their terms, subject to receivership, conservatorship and supervisory powers of bank regulatory agencies, bankruptcy, rehabilitation, liquidation, insolvency reorganization, moratorium, fraudulent transfer, preferential transfer and similar Laws of general applicability relating to or affecting creditors’ rights and remedies generally and to general equity principles.

  • Seller Plan means any Employee Benefit Plan that is maintained or sponsored by the Seller or any Subsidiaries of the Seller (other than the Companies and their Subsidiaries) for the benefit of any current or former NewCo Employee.

  • Privileged Information Exception With respect to any Privileged Information, at any time (a) such Privileged Information becomes generally available and known to the public other than as a result of a disclosure directly or indirectly by the party restricted from disclosing such Privileged Information (the “Restricted Party”), (b) it is reasonable and necessary for the Restricted Party to disclose such Privileged Information in working with legal counsel, auditors, taxing authorities or other governmental agencies, (c) such Privileged Information was already known to such Restricted Party and not otherwise subject to a confidentiality obligation and/or (d) the Restricted Party is (in the case of the Master Servicer, the Special Servicer, the Operating Advisor, the Certificate Administrator, any affected Serviced Companion Loan Holder, the Trustee and the Asset Representations Reviewer, as evidenced by an Officer’s Certificate (which shall include a certification that it is based on the advice of counsel) delivered to each of the Master Servicer, the Special Servicer, the applicable Directing Holder, the applicable Consulting Parties, the Operating Advisor, the Certificate Administrator, the Trustee and the Asset Representations Reviewer) required by law, rule, regulation, order, judgment or decree to disclose such information.

  • Toll Billing Exception Service (TBE) means a service that allows End Users to restrict third number billing or collect calls to their lines.

  • R&W Policy means those certain buyer-side representations and warranties insurance policies purchased by Buyer in connection with this Agreement.

  • Toll Billing Exception Service (TBE means a service that allows End Users to restrict third number billing or collect calls to their lines.

  • Claims-made coverage means an insurance contract or provision limiting

  • Purchaser Plans shall have the meaning set forth in Section 6.6(a)(v).

  • SAP Policies means the operational guidelines and policies applied by SAP to provide and support the Cloud Service as incorporated in an Order Form.

  • CSR Policy means the present Corporate Social Responsibility Policy of the Company, which covers the activities to be undertaken by the Company as specified in Schedule VII to the Act and the CSR Expenditure thereon.

  • Seller Plans has the meaning set forth in Section 3.13(a).

  • Blanket insurance policy means a group policy covering a defined class of

  • Equitable Exceptions means, with respect to the enforceability of any obligation, that such obligation is subject to (a) applicable bankruptcy, insolvency, moratorium, receivership, assignment for the benefit of creditors or other similar state or federal laws affecting the rights and remedies of creditors generally (including, without limitation, fraudulent conveyance or transfer laws) and judicially developed doctrines in this area, such as equitable subordination and substantive consolidation of entities and (b) equitable principles (whether considered in a proceeding in equity or at law).

  • Insurance Policy With respect to any Mortgage Loan included in the Trust Fund, any insurance policy, including all riders and endorsements thereto in effect, including any replacement policy or policies for any Insurance Policies.

  • Title Insurance Policies means, with respect to each Individual Property, an ALTA mortgagee title insurance policy in a form acceptable to Lender (or, if an Individual Property is in a State which does not permit the issuance of such ALTA policy, such form as shall be permitted in such State and acceptable to Lender) issued with respect to such Individual Property and insuring the lien of the Mortgage encumbering such Individual Property.

  • Claims Made Policies has the meaning set forth in Section 5.01(b).

  • Reimbursement insurance policy means a policy of insurance

  • Company 401(k) Plan shall have the meaning set forth in Section 6.09(e).

  • Lapsed Policy means a Policy which has not acquired the Surrender Value and where the due Premium has not been received till the expiry of the Grace Period.

  • Insurance Policies has the meaning set forth in Section 3.16.