hawk-i Specific Exclusions and Limitations

Specific Exclusions and Limitations

• Quantity Limits
• Step Therapy
• Medical Exceptions
• Search the hawk-i Wellmark Drug List

Quantity Limits

The following drugs have a quantity limit:

Step Therapy

Drugs which require step therapy are as follows: 
*See Medical Exception process for request requirements.

• Adderall XR - failure with two different generic CNS Stimulants with a trial of one month each
• Metadate CD - failure with two different generic CNS Stimulants with a trial of one month each
• Stratera - failure with two different generic CNS Stimulants with a trial of one month each

Medical Exception Requests 

Requests will be reviewed for Medical Exceptions on a per patient basis. This process is intended for members with severe medical situations requiring medications not covered by the hawk-i program.

Medical Exception Requests must be submitted by the prescribing physician in writing within 60 days of the denial. The request should include: 

• The date of the request.
• The member's name.
• The member's ID number.
• The provider's name and phone number.
• A copy of the prescription.
• A brief description of the medical reason for the need of the exception.
• Medical records supporting the request.
 

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