Coverage Determination Request

To submit a coverage determination request, complete the Medicare Prescription Drug Coverage Determination Request Form:

2012_Coverage_Determination

Coverage Determinations: Exceptions

Exceptions are also called coverage determinations. Members can request an exception to the Bridgeway tiered cost-sharing structure or to the Bridgeway formulary.

Once Bridgeway approves an exception, we cannot require a member to request approval for a refill or new prescription to continue using the Part D prescription drug approved under the exceptions process for the remainder of the plan year. In order to keep the exception in place for the whole year, the member must remain enrolled in Bridgeway, the member’s physician or other prescriber must continue to prescribe the drug and the drug must be safe for treating the member’s condition.

When an exception request is approved, Bridgeway will give the member written approval letter and will clearly identified the date that coverage will end.

Bridgeway requires members to resubmit an exceptions request at the beginning of a new plan year.

If Bridgeway changes our formulary or the cost-sharing status of a drug during the plan year, we will give written notice to affected enrollees at least 60 days in advance of the change becoming effective. If Bridgeway is unable to give a 60 day advance notice, Bridgeway will supply the drug affected by the change and give written notice at the time of refill.

If you, or your provider would like to request an exception, click here.

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Last updated 2/02/2012