Criteria for Coverage of Exception Status Drugs:
Forms for Exception Status Drug Requests:
- Standard Exception Status Drug Request Form (PDF)
- Request for Coverage of Proton Pump Inhibitors (PDF)
- Injectable Vitamin B12 Form (PDF)
- Drugs for the Treatment of Alzheimer's Disease
- Request for Coverage for Clopidogrel (Plavix) Form (PDF)
- Osteoporosis Therapy Request Form (PDF)
- Chronic Obstructive Pulmonary Disease (COPD) Therapy Form (PDF)
- Request for Coverage for Selective 5HT 1 - Receptor Agonists (PDF)
- Request for Coverage of Restricted Rheumatoid Arthritis Drugs
- Request for Coverage of Anti-TNF Agents for Psoriasis