If a member is requesting a coverage determination or an exception, please fill out the appropriate form below and fax your request to either Express Scripts at 877-837-5922 or Curascript at 888-773-7386. A decision about whether VillageHelath will cover a Part D prescription drug can be a “standard” coverage determination (prior authorization) that is made within the standard timeframe typically within 72 hours. Turn around times for non- formulary exceptions and tier exceptions are typically within 72 hours upon receipt of completed information. If incomplete information is given, then the turnaround time will be delayed up to 14 days. Once a decision has been made, Express Scripts will send a letter to the physician's office and the member regarding the decision of the coverage determination. To check the status of a coverage determination and exception request, please call Express Scripts at 800-417-8164 or Curascript at 888-773-7376. 2008 Specialty General Request 2008 Non-Formulary Drug Request 2008 Tier Exception acetazolamide Actimmune-interferon gamma 1b Actoplus Met-Pioglitazone and Metformin Adagen Aldurazyme Anadrol-50 anagrelide-Agrylin Ancobon-flucytosine Aranesp-darbepoetin alfa Avandamet-Rosiglitazone and Metformin B vs. D- Immunosuppressants B vs. D- Oral Anti-Emetics Betaseron-interferon beta 1b Byetta Cancidas Carimune Celebrex-celecoxib Copaxone-glatiramer desmopressin-DDAVP Elmiron-pentosan polysulfate sodium Emend-aprepitant Enbrel-etanercept Entocort EC-budesonide Felbatol-felbamate Forteo-teriparatide Gammagard-immune globulin Gleevec-imatinib Humira-adalimumab Intron A-interferon alfa-2b Iplex Janumet-sitagliptin and metformin Lipitor 80mg-atorvastatin Lyrica-pregabalin Marinol-dronabinol metformin-glipizide metformin-glyburide metformin Miacalcin Inject-calcitonin salmon midodrine-ProAmatine Myfortic Naglazyme nefazodone-Serzone Neupogen-filgrastim Neutrexin Nexavar-sorafenib nitrofurantoin Noxafil Omacor-omega 3 acid ethyl esters Orfadin-Nitisinone Peg Intron-peginterferon alfa probenecid Procrit-epoetin alfa Prograf-tacrolimus Proleukin Provigil-modafinil Ranexa-ranolazine Raptiva-efalizumab Revatio-sildenafil citrate Revlimid-lenalidomide Rilutek-riluzole Roferon A-interferon alfa 2a Serostim-somatropin Somavert-Pegvisomant Soriatane-acitretin Sprycel-Dasatinib Strattera-Atomoxetine sucralfate Sutent-sunitinib Symlin-pramlintide acetate Tarceva-erlotinib Targretin-bexarotene Thalomid-thalidomide Thioguanine thioridazine-Mellaril ticlopidine-Ticlid Topamax-topiramate Trisenox-Arsenic Trioxide Tykerb Velcade-Bortezomib Vidaza-Azacitidine Zavesca-Miglustat Zolinza Physician Coverage Determination Link