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En español | There are a number of reasons why your plan may not cover a drug that is on its list of covered drugs (also called a formulary). Here are a few examples

  • Your plan requires that your doctor or other prescriber ask for special permission (“prior authorization”) before it will consider covering the drug.
  • Your plan will only cover a certain amount of a prescription (“quantity limits”). For example, if your doctor is prescribing more than the amount approved on the formulary, the prescription may be denied.
  • You must first try a less-expensive medication before your plan will cover a more-expensive one (“step therapy”).

These restrictions are to help ensure safe and appropriate use of drugs prescribed for you. If your plan denies coverage, you can request an “exception” through your drug plan. Ask your doctor, other prescriber or pharmacist to help you complete the paperwork.

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