Exception Status Drugs
Criteria for Coverage of Exception Status Drugs:
Forms for Exception Status Drug Requests:
- Standard Exception Status Drug Request Form
- Request for Coverage of Restricted Proton Pump Inhibitors
- Injectable Vitamin B12 Form
- Drugs for the Treatment of Alzheimer's Disease
- Request for Coverage for Clopidogrel (Plavix) Form
- Osteoporosis Therapy Request Form
- Chronic Obstructive Pulmonary Disease (COPD) Therapy Form
- Request for Coverage for Selective 5HT 1 - Receptor Agonists
- Request for Coverage of Anti-TNF Agents for Psoriasis
- Request for Coverage of Anti-TNF Agents for RA
- Pharmacist Exception Status Drug Request Form
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Page last updated 2012-03-27.