You may use the exception process to ask us to cover a drug that is excluded, or to request an exception to a quantity limit. Drugs are excluded from coverage if they are not listed in the Prescription Drug List.
You may submit a request via fax to, MedImpact Healthcare Systems, Inc. at (888) 807-6643 using the applicable request form.
You may also request an exception by calling MedImpact’s Customer Service at (800) 788-2949. For a faster decision, you must include the necessary medical information, upon the initial request. We will only grant exceptions for clinical reasons. You must provide a statement that explains why an exception is Medically Necessary, including why the covered drugs on the Prescription Drug List are not as effective as the requested drug. We will act on a request for an exception within two business days of receiving your statement of the reasons an exception is Medically Necessary.
You may request an expedited exception when one of the following situations occurs:
We will notify you of a decision no later than 24 hours after receiving your expedited request.
- The delay could seriously jeopardize your patient’s life, health or ability to regain maximum function; or
- Your patient is undergoing a current course of treatment using a non-formulary drug
Your request for an exception will be considered by pharmacists and other appropriate practitioners. If we deny your request, we will tell you the reason for the denial and explain the process for requesting an appeal of our decision.