Tier Exception Letter Sample For Student
Description
How to fill out Sample Letter For Exception To Determination Of Civil Penalty?
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FAQ
A Formulary Exception Request Letteris a written request asking that the restriction placed on a specific medication be released as it is medically appropriate and necessary for the patient's treatment.
Exceptions requests are granted when a plan sponsor determines that a requested drug is medically necessary for an enrollee. Therefore, an enrollee's prescriber must submit a supporting statement to the plan sponsor supporting the request.
A tiering exception is a type of exception request through the Part D appeal process. You can request lower cost-sharing for a prescription on a higher tier if you show that similar drugs on the formulary at lower tiers are ineffective or harmful for you.
Ask your plan how to send your tiering exception request. It is usually helpful to include a letter of support from your prescribing physician. This letter should explain why similar drugs on the plan's formulary at lower tiers are ineffective or harmful for you.
For tiering exceptions, the prescriber's supporting statement must indicate that the preferred drug(s) would not be as effective as the requested drug for treating the enrollee's condition, the preferred drug(s) would have adverse effects for the enrollee, or both.