There may be drugs that aren’t on your prescription drug list or that have special requirements, such as preauthorization or step therapy, that you will need to meet before they are covered.
Some drugs have special requirements that must be met before Scripius will cover them.
Step Therapy drugs require your provider to first prescribe alternative options that are generally more cost-effective without compromising quality. Step therapy may be waived if determined to be medically necessary.
Preauthorization is required for certain drugs. This process should be completed by your doctor before you fill your prescription.
If your doctor believes that you require a medication that is not on your formulary, normally requires step therapy, or exceeds a quantity limit, they may request an exception through the preauthorization process or the drug exception process.
Use our drug search to see if any of the medications you are taking have special requirements or indicators.
If you need a prescription for a medication that is normally not covered under your plan, you may ask for an exception to your plan’s prescription drug coverage. Obtaining an exception decision takes between 24 hours (emergent) and 72 hours (standard). Many requests can be done over the phone by calling 800-442-3127. Some requests must be submitted by your doctor. If the exception is denied, you have the right to appeal that decision, just like any other denial.
Access the drug exception form.
