Member Initiated Exception Process for Non-Formulary Drugs

Prior to purchasing a non-formulary drug, you may ask for an exception request. This process may permit coverage for a drug that is otherwise not covered if it meets Wellmark’s medical exception criteria.

 

To begin this process:

  1. Complete the member portion of the Member Initiated Exception Request Form for Noncovered Pharmaceuticals pdf and then forward the form to the prescribing physician.
    or
    Contact Wellmark Customer Service at the toll-free number printed on your ID card.

  2. The prescribing physician will complete his/her section, then fax the completed form to Wellmark for review.

  3. 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.

  4. If the exception request is denied, Wellmark Pharmacy Operations will send a letter to the prescribing physician and the member.
 
 
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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
 
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