Medical Exception Request Online

Request coverage for drugs not included on your formulary.

As a CDPHP member, you can begin the process to have a drug not included on the CDPHP formulary (list of covered drugs) reviewed for coverage.

CDPHP will contact the provider listed in your request for the information needed to make a decision for coverage. After all necessary information is obtained from your provider, a decision will be made by CDPHP.

Once a decision has been made, you will be contacted by phone by either CDPHP or your provider and you will receive a decision letter in the mail from CDPHP.

Please fill out all of the information below prior to clicking the submit button. Your information will automatically be sent to CDPHP for review.

The information you provide will be used only for this review and all information will be kept confidential.