If yes, your prescriber is required to submit a special request for you to request that the medication be covered for you.
If the request is approved, then the medicine would be covered for you in the same way as a regular formulary benefit is managed. In most cases, the approval is valid for a year, after which a new request must be submitted. However, for some commonly prescribed products, renewals are not required. A list of these products is available online.
If the product is denied, then it would not be covered by the plan and not eligible to be calculated as part of your cost-sharing responsibilities. In that case, please click here to learn more.
