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Prior to purchasing a non-formulary drug, you may ask for a medical necessity review. This process may permit coverage for a drug that is otherwise not covered if it meets Wellmark’s medical exception criteria. Note: This form is different than a prior authorization request which allows Wellmark to verify a prescription drug is part of a specific treatment plan.
To begin this process:
- Complete the member portion of the Member Necessity Review Form for Non-Formulary Drugs
 (106KB) and then forward the form to the prescribing physician.
or
Contact Wellmark Customer Service at the toll-free number printed on your ID card.
- The prescribing physician will complete his/her section, then fax the completed form to Wellmark for review.
- If additional information is necessary or if the form is not completed with all of the required information, Wellmark will contact the physician for the missing information. If the prescribing physician does not provide the missing information within three business days, the request will be denied and a new request will be needed.
- If the exception request is denied, Wellmark Pharmacy Operations will send a letter to the prescribing physician and the member.
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