Information about any prior authorization or step therapy requirements for specific prescription drugs can be found by searching for the drug on the Peoples Health formulary. Input the name of the drug in the formulary search field. In the search results chart, select the Prior Authorization or Step Therapy link in the results if applicable.
You can request tiering exceptions and formulary exceptions for your Peoples Health patients.
- Tiering exceptions request a higher level of coverage for a drug. If a drug is in tier 2 (generic tier), you can request that Peoples Health cover it as a tier 1 (preferred generic tier) drug. If a drug is in tier 4 (nonpreferred drug tier), you can request that Peoples Health cover it as a tier 3 (preferred brand tier) drug. You cannot ask us to change the cost-sharing for a tier 1, tier 3 or tier 5 (specialty tier) drug.
- Formulary exceptions ask us to cover a drug that is not on our formulary, or to waive coverage restrictions or quantity limits on a drug that is covered by our formulary. If we agree to a formulary exception, the patient pays the copay that applies to a tier 4 drug.
To request prior authorization or a tiering or formulary exception, visit https://professionals.optumrx.com or fax a Request for Medicare Prescription Drug Coverage Determination Form to the number on the form. A copy of the form can be found at www.peopleshealth.com/formulary.