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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.

  • 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.

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

  • Members, members' representatives, or members' prescribing physicians or other prescribers ("Prescriber") may submit an oral or written request to MedImpact to request a Coverage Determination, Tiering Exception, or Formulary Exception.

Related to Formulary Exception

  • Seller 401(k) Plan has the meaning set forth in Section 6(e) below.

  • Enforceability Exceptions means the (a) Laws of general application relating to bankruptcy, insolvency and the relief of debtors; and (b) rules of law governing specific performance, injunctive relief and other equitable remedies.

  • 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.

  • 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 maintained, or contributed to, by the Seller, any Subsidiary or any ERISA Affiliate.

  • 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 that certain representations and warranties insurance policy issued by the R&W Insurer to the Buyer.

  • 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 a statement containing the approach and direction given by the board of a company, taking into account the recommendations of its CSR Committee, and includes guiding principles for selection, implementation and monitoring of activities as well as formulation of the annual action plan;

  • 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).

  • Part 70 Source means any source subject to the permitting requirements of R307-415.

  • Reimbursement insurance policy means a policy of insurance

  • Company 401(k) Plan has the meaning set forth in Section 6.4(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.

  • Covered policy means a policy of commercial risk insurance, professional liability insurance or public entity insurance.

  • R&W Insurance Policy means the representations and warranties insurance policy issued to Buyer in connection with the transactions contemplated hereby.

Most Referenced Clauses

Most Referenced Definitions