Drug exceptions time frames and member responsibilities
A member or provider may request an exception for non-covered formulary medication in lieu of a covered medication by submitting a letter of medical necessity from the prescribing provider. Information must be submitted by the provider on letterhead via a letter of medical necessity including the following: member name, failed therapies, diagnosis, and member identification number. The letter should be faxed to the attention of the Pharmacy department at 501-378-6980. Medical records may be requested to demonstrate the medical need for the excluded drug. Once all necessary information is received, a determination will be made within 72 hours and the member and provider will be notified. Expedited review requests due to exigent circumstances must be noted as such on the letter and must contain all required information, in order to be reviewed within 24 hours of this request.
If the member's request is denied, the member has the right to request an appeal. Appeal information must be submitted in writing and must include the reason the member and/or the provider disagrees with the determination and any supporting information.
Mail appeals to:
Arkansas Blue Cross Blue Shield
Attn: Appeals Coordinator
PO Box 2181
Little Rock, AR 72203-2181
Urgent appeals may be faxed to 501-378-3366. The member and/or physician may request a clinically appropriate specialist or an external review organization to review the request. This request must be submitted in writing and may be faxed.