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Medical Exception Request Online

Request coverage for drugs not included on your formulary.

As a CDPHP member, you can start the process to have a drug not on the CDPHP list of covered drugs reviewed to be covered for you. We will reach out to the provider you list in your request for the information we need for this review. After all information is received from your provider, a decision will be made by CDPHP.

You will receive a call by either CDPHP or your provider with the decision. You will receive a letter from CDPHP with the decision.

Please fill out all information below and then click the submit button. This information will be kept private.