hawk-i Program

Member Initiated Exception Process for Noncovered Drugs

Prior to the purchase of a noncovered drug, a hawk-i enrollee (or their parent or legal guardian) 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, the member, parent, or legal guardian may complete the member portion of the Member Initiated Exception Request Form for Noncovered Pharmaceuticals and then forward the form to the prescribing physician, or may contact Wellmark Customer Service at the toll-free number printed on the hawk-i enrollee’s ID card. Upon receipt, the prescribing physician will complete his/her section, then fax the completed form to Wellmark Pharmacy Operations for review.

If additional information is necessary or if the form is not completed with all of the required information, Wellmark Pharmacy Operations 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 hawk-i member.

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