Can I request a medication not listed on the formulary?

Express Scripts has a specific formulary that outlines the medications covered under their plans. If a particular medication is not listed on the formulary, it may still be possible to request it through a process known as a prior authorization. This process involves providing justification for the need for the non-formulary medication, which may include information from a healthcare provider regarding the patient's medical condition and the reasons why the preferred alternatives would not be appropriate. The healthcare provider typically submits this request on behalf of the patient, along with any supporting documentation. It is important to gather all necessary information to facilitate the review process. After the submission, Express Scripts reviews the request and communicates the decision regarding coverage. For the most accurate and up-to-date information regarding the formulary, possible exceptions, and the prior authorization process, it is advisable to refer to the official Express Scripts website. This site will provide detailed instructions and contact information if further assistance is needed. It is always best to consult with a healthcare provider to discuss the options available based on individual circumstances.