If yes, the prescriber has to write the appropriate code on the prescription for it to be covered. However, when a medication is prescribed for purposes different from those that are approved, your prescriber has to submit a request for coverage that includes the medical rationale for how the medication would be used. This request must be approved before the medication is covered.
In addition, prescribers may request that the medication be covered for your specific circumstances if it is not included on the List of Medications. In such cases, your prescriber must complete and submit the appropriate form that includes the reason that the normally unfunded treatment is required for you. If the request is approved, the medication would be covered for you but not all other patients in similar circumstances.
