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Medication Exception Requests

You can ask HealthMarkets Care AssuredSM to make an exception to a covered medication policy. There are several types of exceptions you can request:

  1. You can ask us to cover your drug even if it is not on our formulary; or
  2. You can ask us to waive coverage restrictions or limits on your drug.

Generally, HealthMarkets Care Assured will only approve an exception if the alternative drugs included on the plan’s formulary, the low-tiered drug or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.

To request a medication exception, print out the Medication Exception Request Form. Mail the completed form, along with a statement from your physician supporting your request, to the following address:

HealthMarkets Care Assured
c/o: SilverScript Appeals Dept.
MC109
P.O. Box 52000
Phoenix, AZ 85072-2000

Or, you can FAX the documents to: 1-866-884-9475.

Download Coverage Determination Form.

CMS APPROVAL 11/24/2007
H7845_MM_NA_E_4006_3_ALL

Underwritten by

The Chesapeake Life Insurance CompanySM