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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2016

Update to Formulary Exception Request Process


Effective immediately, any approvals for medications submitted as formulary exception requests for members of our Value formularies will approve at the highest tier copayment/coinsurance.

Providers can use the formulary exception process to request, for clinical reasons, that Harvard Pilgrim cover a drug that is not included on a member’s formulary, or to obtain a quantity above the quantity limit for the requested medication.

To request an exception, send a completed Formulary Exception Request Form to MedImpact Healthcare Systems, Inc. at 888-807-6643. Please review the Exception Process page on Harvard Pilgrim’s website for more detailed information on how to submit a request for a formulary exception, what information must be provided to demonstrate medical necessity, and the circumstances under which an expedited exception may be requested. 

Also available for your reference is the drug lookup tool, found on the Pharmacy Page in the provider section of our website, where you can see what is covered for your patient to determine if a formulary exception may be necessary.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

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Writer

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Production Coordinator