If yes, the prescriber is required to submit a written request containing enough details to permit a thorough objective assessment to have it covered. In cases when the medication is listed with specific criteria, the prescriber is only to tell the program that the specified criteria have been met.
However, when a medication is prescribed for different purposes, the request for coverage must include an explanation of the medical rationale for how you would use this medicine, provided by your prescriber. You can request an initial 30-day coverage of the medication from the pharmacist to meet your needs while the request is under consideration.
In addition, prescribers may request the use of medications not included on the formulary in individual cases. In such cases, a prescriber must complete and submit a request indicating the reason that you require the medication. If the request is approved, the medication would be reimbursed for you as a specific patient – it would not be added to the formulary for all patients.
