Beginning January 1st 2025, certain medications will not be included as part of your prescription drug formulary. Drugs not listed on the formulary are called non-formulary or excluded drugs. A medication may be excluded from coverage under your pharmacy benefit when it works similarly to another prescription drug or over-the-counter (OTC) medication. Please speak with your provider about medication options.
You or your provider may request an exception for coverage of a non-formulary drug. Certain criteria for medical necessity must be met. To submit a non-formulary exception request:
- Your doctor can submit a prior authorization request for a non-formulary medication to WHA using the “Prescription Drug Prior Authorization or Step Therapy Exception Request Form” located here, or by submitting an electronic prior authorization (ePA) request through CoverMyMeds.
- Call the customer service number on your WHA ID card to initiate an inquiry for coverage of a non-formulary medication from your provider. WHA will send an inquiry to your provider on your behalf.
- Fill out the secure online form. When you are finished, click the "Submit and Review" button at the bottom of the page. WHA will send an inquiry to your provider on your behalf.
Please Note: Your inquiry or online submission does not constitute a coverage request. The request for coverage cannot be processed until WHA has received a completed prior authorization form from your doctor. Once the completed prior authorization form is received from your provider, WHA will review it based on urgency (24 hours or 72 hours) noted by your provider. If WHA does not receive a prior authorization within 7 days after your inquiry, you will receive a phone call from WHA’s pharmacy team to let you know of our efforts.