Drug Not Covered?

What to do if a drug is not covered

If your prescription is not listed in the Drug Lists or is restricted, there are a couple things you can do. 

First, please contact our Member Services Department to confirm that your desired drug is not covered. Our Drug Lists are updated regularly and this could save you extra steps.  If your drug is not covered, you have two options.

  1. You can change to another drug

    Start by talking with your provider. There may be another drug available to you that might work just as well. Member Services can share a list of covered drugs that treat the same medical condition you have. This list can help your provider find a covered drug that might work for you  --OR--

  2. You can ask for an exception

    If your doctor believes that you need a certain drug for medical reasons, he/she can help you request an exception. This means that you can ask us to cover a drug that is not on our Drug List. You can also ask us to cover a drug that is on the Drug List but remove the restrictions that we have on that drug. Learn how to request an exception.

New Members can receive drugs not listed on the Drug Lists for a short time

You may be eligible to receive an initial transition supply of a drug anytime during the first 90 days you are a plan member. This will give you time to talk to your doctor and find a good alternative that is covered by our plan. Learn more about drug coverage for new members.