Non-Formulary Prescription Form - Kaiser Permanente - Community ... - providers kp 2025

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Ozempic is non-formulary, but available to most beneficiaries at the non- formulary cost share. You do NOT need to complete this form in order for non-Active Duty beneficiaries (spouses, dependents, and retirees) to obtain non-formulary medications at the non-formulary cost share.
A formulary is a list of generic and brand name prescription drugs covered by your health plan. Non-formulary drugs typically only include brand-name medications and come with high out-of-pocket expenses.
The process for getting a non-formulary drug covered by insurance involves your healthcare provider submitting a prior authorisation request to your insurance company. This request includes medical justification for the necessity of the non-formulary drug over available formulary options.
Non-formulary medicines should be prescribed only when formulary choices are not suitable or have been exhausted. Non-formulary prescribing should not be used to bypass usual NHS commissioned pathways.
A formulary is a list of generic and brand name prescription drugs covered by your health plan. Non-formulary drugs typically only include brand-name medications and come with high out-of-pocket expenses. Your health plan may only help you pay for the drugs listed on its formulary.
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A non-formulary drug refers to any medication that isnt included on your health insurance plans formulary. These drugs are oftentimes not covered meaning that you will likely have to pay the full price unless you take steps to request coverage.

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