A Healthy CollaborationSM

Exceptions and Prior Authorization

What is an Exception?

A member can request an exception to our formulary if we will not provide or pay for a Part D prescription drug that a member’s doctor has prescribed because it is not on our list of covered drugs (called a “formulary”). Or, if the member disagrees with the amount that we require to pay for a Part D prescription drug a member’s doctor has prescribed, a member can request an exception to the co-payment we require to pay for a drug.

What is a Prior Authorization?

Today’s Options® PPO requires you to get prior authorization for certain drugs. This means that you will need to get approval from Today’s Options PPO before you fill your prescription. If you don’t get approval, Today’s Options PPO may not cover the drug.

This page allows you to print Exception and Prior Authorization forms.

You can search for forms using the Searchable Formulary.

M0018_TOPPO_209 Pending CMS Approval Last updated: 4/1/2022

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