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Formulary Exceptions

Meaning

Formulary Exceptions are a formal administrative and clinical process that allows a patient to receive coverage for a prescribed medication that is not routinely included on their health plan’s list of covered drugs, known as the formulary. This exception is granted only when the formulary-preferred alternatives are clinically inappropriate, ineffective, or carry a high risk of adverse effects for the specific patient’s condition. Successfully navigating this process is critical for individualized pharmaceutical care.