Current Members

When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. Your doctor or other prescriber must give us a written statement that explains the medical reasons for requesting an exception. For a faster decision, include this medical information from your doctor or other prescriber when you ask for the exception.

A decision about whether SCAN will cover a non-formulary exception or tier exception can be a “standard” coverage determination that is made within the standard timeframe typically within 72 hours of getting your prescribing physician’s supporting statement. If the necessary information is not received within 14 days, a decision will be rendered based on the limited information provided. You may request for a “fast” decision (expedited review) only if your physician believes that waiting for a standard decision could seriously harm your health or your ability to function. If your request to expedite is granted, a decision will be made no later than 24 hours after we get your prescribing physician’s supporting statement. Once a decision has been made, Express Scripts will send a letter to you and your physician regarding the decision of the coverage determination.

Your doctor or prescriber should fill out one of the exception forms provided below and mail it to the following address:

The exception request can also be faxed to Express Scripts at 1-877-837-5922 (Attention: Prior Authorization Department - Part D).

2011 Non-Formulary drug Request form
2011 Specialty General Request Form (Revised)
2011 Tier Exception Request Form

To check the status of a an exception request or for additional assistance in making this request, please contact Member Services at 1-800-559-3500 (TTY Users: call 1-800-735-2929).

You can find detailed information regarding the Formulary Exception process in your Evidence of Coverage booklet under Chapter 9, Section 6.2: What is an Exception?.