Updated July-2026-27

CVS Caremark Formulary Exception Form: How to File It Correctly

Evan Brown
Written by Evan Brown
Medical Content Researcher
Dr Megan Harris Medically Reviewed by Dr. Megan Harris, MD
Policy Review: This guide is based on CVS Caremark's published Formulary Exception/Prior Authorization Request Form, its provider-facing prior authorization program pages, and CMS Part D exception timeline rules.
Quick Answer

CVS Caremark handles formulary exceptions through the same document it uses for standard prior authorization: the Formulary Exception/Prior Authorization Request Form. Your prescriber's office fills it out — patient and prescriber information, the specific drug and strength, clinical documentation showing why formulary alternatives won't work, and a signature — and submits it electronically (ePA), by fax, or occasionally by phone. There is no separate "exception-only" form to search for; the exception request and the prior authorization request share the same paperwork, with the clinical-necessity section doing the work either way. For Medicare Part D plans, CVS Caremark must generally decide standard requests within 72 hours and expedited requests within 24 hours, per CMS rules. If denied, you can appeal — commonly called a redetermination for Part D — and further independent review levels exist beyond that if the appeal is also denied.

Key Takeaways

  • One combined form covers formulary exceptions, quantity limit exceptions, and step therapy exceptions.
  • Your prescriber's office submits it — electronically, by fax, or by phone — not you directly.
  • Medicare Part D timelines: 72 hours standard, 24 hours expedited, per CMS requirements.
  • Missing clinical documentation, not eligibility itself, is the single most common cause of delay.
  • A denial isn't final — appeal (redetermination) and further external review levels are available.

"Formulary exception" sounds like it needs its own special paperwork, separate from ordinary prior authorization. It doesn't. CVS Caremark runs both processes through the same Formulary Exception/Prior Authorization Request Form, and the confusion over that fact is probably the single biggest reason people delay filing one.

A formulary exception is really just a specific type of prior authorization request: instead of asking permission to use a drug that requires PA by design, you're asking Caremark to cover something that isn't on the formulary at all, or to waive a quantity limit or step therapy requirement standing in the way of it. The mechanism — one form, filled out by your prescriber, reviewed against clinical criteria — is identical either way.

This guide walks through exactly what that form asks for, how to submit it correctly the first time, what timelines apply once it's in, and what to do if it comes back denied.

Table of Contents

  1. What a Formulary Exception Actually Is
  2. The Three Request Types on One Form
  3. What the Form Actually Asks For
  4. How to Submit: ePA, Fax, or Phone
  5. Review Timelines
  6. A Real Example, Start to Finish
  7. Decision Tree: Which Box Do You Check?
  8. Step-by-Step: Filing Without Delays
  9. If You're Denied: Appeals and External Review
  10. Common Mistakes That Cause Denials
  11. Frequently Asked Questions

What a Formulary Exception Actually Is

Every health plan's pharmacy benefit is built around a formulary — a list of covered drugs, organized into tiers, with rules attached to some of them. A formulary exception is a request to step outside that list or those rules for a specific patient, based on medical necessity.

Situation Is It a Formulary Exception?
Drug isn't on the formulary at all Yes — non-formulary exception
Drug is covered but limited to a certain quantity per month Yes — quantity limit exception
Drug requires trying a cheaper alternative first Yes — step therapy exception
Drug is covered on formulary, no restrictions, but at a high copay tier Sometimes — tiering exception, requesting a lower cost-sharing tier
Drug simply requires standard prior authorization for safety reasons No — this is ordinary PA, though the same form is used

The Three Request Types on One Form

CVS Caremark's Formulary Exception/Prior Authorization Request Form is built to handle several distinct scenarios without needing a different document for each one.

Request Type What You're Asking For Key Documentation Needed
Non-formulary exception Coverage for a drug not on the plan's formulary at all Explanation of why formulary alternatives aren't appropriate or effective
Quantity limit exception A higher quantity than the plan's standard limit allows Clinical rationale for the higher dose or quantity
Step therapy exception Skipping or bypassing a required "try this first" drug History of failure, intolerance, or contraindication to the required step drug
Tiering exception A lower copay tier for a drug that's covered but expensive Evidence that lower-tier alternatives are ineffective or not tolerated

You can request more than one type at once. If a drug is both non-formulary and would need a quantity above the standard limit, your prescriber can document both issues on the same submission rather than filing twice.

What the Form Actually Asks For

CVS Caremark's own guidance is direct about this: providing only demographic and drug information isn't a sufficient request. The clinical documentation is what actually gets reviewed.

Section What Goes Here
Patient information Name, date of birth, member ID, plan information
Prescriber information Name, NPI, contact details, office fax number for the response
Medication requested Drug name, strength, dosage form, quantity, and days' supply
Diagnosis ICD-10 code and clinical description supporting medical necessity
Clinical documentation Prior treatments tried, outcomes, contraindications, relevant lab or visit notes
Expedited review checkbox Checked only when standard timing would seriously jeopardize the patient's life, health, or ability to regain maximum function
Prescriber signature and date Certification that the requested medication is medically necessary

Certain drug classes have their own extra questions built into the form — CVS Caremark's global PA form includes specific criteria sections for categories like anti-obesity medications, continuous glucose monitors, insulin pumps, triptans, and testosterone products, among others. If your medication falls into one of these categories, expect additional clinical questions beyond the general sections.

How to Submit: ePA, Fax, or Phone

CVS Caremark accepts prior authorization and exception requests through more than one channel, and which one your prescriber's office uses often comes down to what their EHR or practice management system supports.

Method How It Works Best For
Electronic Prior Authorization (ePA) Submitted directly through the prescriber's EHR or a connected ePA platform Fastest turnaround, fewer transcription errors
Fax Completed form faxed to CVS Caremark's prior authorization department Practices without ePA integration
Phone Prescriber or authorized agent calls Caremark's Prior Authorization Department to answer criteria questions directly Simple, straightforward cases with limited documentation needs

Fax numbers and phone lines vary by plan. CVS Caremark administers pharmacy benefits for many different employer and health plans, each of which can have its own dedicated fax number or phone line. Always use the number printed on your specific insurance ID card, member portal, or the request form your prescriber's office actually has on file — a number found through a generic web search may route to the wrong plan's queue and cause delays.

Review Timelines

Timelines differ by plan type, but Medicare Part D plans — which CVS Caremark administers for many insurers — follow specific timeframes required by CMS.

Plan Type Standard Review Expedited/Urgent Review
Medicare Part D Generally within 72 hours Generally within 24 hours
Commercial/employer plans Varies by plan; often a similar standard/urgent structure applies under federal claims procedure rules Typically faster, reserved for cases where delay could seriously harm the patient
Medicaid managed care Varies by state; often subject to state-specific timeframes Varies by state; expedited pathways generally required for urgent cases

The clock generally starts when Caremark has a complete request. A submission missing required clinical documentation may be returned or delayed before the formal review timeline even begins, which is why documentation completeness matters as much as speed of submission.

A Real Example, Start to Finish

Here's how a step therapy exception request might play out for a patient prescribed a brand-name migraine medication after a plan's preferred triptan didn't work.

1

Pharmacy rejects the claim

The pharmacist sees a step-therapy rejection code at the register and tells the patient a prior authorization or exception request is needed.

2

Patient calls the prescriber's office

The office pulls the CVS Caremark Formulary Exception/Prior Authorization Request Form, or accesses the equivalent request through their ePA system.

3

Prescriber documents the step therapy failure

The form's step therapy section is completed with the name of the previously tried triptan, the outcome (inadequate relief, or a specific adverse reaction), and the dates it was used.

4

Submission goes in via ePA

The request is submitted electronically, with the office's fax number included as a backup contact for Caremark's response.

5

Decision arrives within the standard window

Because this wasn't marked urgent, Caremark's decision comes back within the standard review timeframe rather than the expedited one — approved, based on the documented step therapy failure.

Decision Tree: Which Box Do You Check?

Why was the claim rejected at the pharmacy?

The rejection reason determines which exception type applies

Drug Not Covered / Quantity Capped

Check non-formulary or quantity limit exception

Document why alternatives won't work or higher quantity is needed

"Try This First" Rejection

Check step therapy exception

Document prior failure, intolerance, or contraindication

Could waiting seriously harm the patient?

If yes, check the expedited/urgent review box

Submit via ePA, fax, or phone

Use the number/portal tied to the specific plan, not a generic search result

Step-by-Step: Filing Without Delays

1

Confirm the exact rejection reason first

Ask the pharmacist for the specific rejection code or reason, not just "it needs prior authorization." Non-formulary, quantity limit, and step therapy rejections each call for slightly different documentation.

2

Get the correct plan-specific submission method

Check the insurance ID card or member portal for the fax number or ePA pathway tied to your specific plan rather than a generic number found online.

3

Bring your medication history to the appointment

If this is a step therapy exception, having dates and outcomes of previously tried medications ready speeds up the documentation your prescriber needs to write.

4

Ask your prescriber's office who handles PA paperwork

Many practices have a specific staff member or nurse dedicated to prior authorization and exception requests — asking for that person by role can get your request into the right hands faster.

5

Confirm whether urgent review applies

If delaying the medication could seriously jeopardize your health, tell your prescriber's office directly so they can evaluate whether to check the expedited review box.

6

Follow up if you haven't heard back

If the standard or expedited window has passed without a decision, call the number on your ID card to check status rather than assuming denial or waiting indefinitely.

If You're Denied: Appeals and External Review

A denial on a formulary exception request is not the end of the process. Most plans build in at least one internal appeal step and, if that fails, an independent external review.

Stage What Happens
Initial denial You receive a written explanation of the specific reason for denial
Internal appeal (redetermination for Part D) Your prescriber submits additional documentation addressing the stated denial reason
Independent external review A reviewer outside the plan evaluates the case, generally available if the internal appeal is also denied

Read the denial letter closely before appealing. It should state the specific clinical criterion that wasn't met. An appeal that directly addresses that stated reason — rather than simply resubmitting the same information — has a meaningfully better chance of success.

Common Mistakes That Cause Denials

Mistake Why It Causes Problems
Only demographic and drug information submitted Caremark's own guidance states this alone isn't a sufficient request
Missing ICD-10 diagnosis code Reviewers can't evaluate medical necessity without a documented diagnosis
No documentation of prior treatment attempts Step therapy and tiering exceptions specifically require this history
Expedited box checked without justification Can result in the request being reviewed under standard timing anyway if criteria aren't met
Using a fax number for the wrong plan Can misroute the request or cause it to go unprocessed
Missing prescriber signature or date Treated as an incomplete submission

Frequently Asked Questions

CVS Caremark uses a single combined Formulary Exception/Prior Authorization Request Form for non-formulary drug requests, quantity limit exceptions, and step therapy exceptions. Your prescriber's office completes and submits it.

For Medicare Part D plans, CVS Caremark must generally decide standard exception requests within 72 hours and expedited requests within 24 hours, per CMS rules. Commercial plan timelines vary but often follow a similar standard/urgent structure.

Members can request an exception, but CVS Caremark requires a supporting statement from the prescriber explaining medical necessity, so your prescriber's office is almost always involved in the actual submission.

You can file an appeal, often called a redetermination for Medicare Part D plans. If that's denied too, further independent external review levels are generally available, depending on your plan type.

Check the expedited or urgent review box on the Formulary Exception/Prior Authorization Request Form, which requires the prescriber to certify that waiting for the standard timeframe could seriously jeopardize the patient's life, health, or ability to regain maximum function.

Not quite. A formulary exception typically asks for coverage of a drug not on the formulary at all, while a tiering exception asks for a lower copay tier on a drug that's already covered. Both use similar documentation and often the same overall form.

Fax numbers vary by the specific health plan CVS Caremark administers for your coverage. Use the number on your insurance ID card, member portal, or the plan-specific form your prescriber's office has on file rather than a number found through a general web search.

The clinical documentation and certification generally must come from the prescriber, though pharmacists commonly identify the need for the request and direct patients back to their prescriber's office to initiate it.

ePA submissions generally move faster in practice because they reduce manual data entry and transcription errors, though the formal decision timeframe itself is governed by the same standard or expedited rules regardless of submission method.

CVS Caremark's global prior authorization form includes additional category-specific clinical questions for certain drug classes, including anti-obesity medications, testosterone products, and continuous glucose monitors, among others. Expect extra documentation requirements for these categories.


How We Researched This Guide

This guide was prepared by the Refill Relay Editorial Team using CVS Caremark's own published Formulary Exception/Prior Authorization Request Form and provider-facing prior authorization program pages, cross-checked against CMS Medicare Part D exception timeline requirements.


References

  1. CVS Caremark — Prior Authorization program overview
  2. CVS Caremark — Prior Authorization and Exception Forms directory
  3. CVS Caremark — Global Formulary Exception/Prior Authorization Request Form (PDF)
  4. CMS — Medicare Part D Appeals and Exception Timeframes

About Refill Relay

Refill Relay publishes evidence-based educational resources that help patients understand prescription insurance, prior authorization requirements, formulary exceptions and medication access. Our editorial team reads pharmacy benefit manager program pages and CMS guidance directly rather than relying solely on secondhand summaries.

Editorial Standards

  • Sourced from CVS Caremark's own published forms and program pages
  • Clinical and policy review before publication
  • Regular updates when PBM procedures or CMS timeframes change
  • Clear distinction between educational content and legal or medical advice

Related Resources

Editorial Policy: Refill Relay medical content is researched using pharmacy benefit manager program pages and CMS guidance. Because fax numbers, submission portals, and specific plan procedures vary and can change, always confirm the current details for your specific plan directly with CVS Caremark or the number on your insurance ID card before submitting a request.

Evan Brown
About the Author
Evan Brown — Medical Content Researcher

Evan Brown is a medical content researcher who specializes in translating complex pharmacy benefit manager procedures into clear, actionable guidance for patients and caregivers.

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Dr. Megan Harris, MD
Medical Review
Dr. Megan Harris, MD

Dr. Megan Harris, MD reviews health content for medical accuracy, checking clinical documentation standards against current CMS and PBM guidance.

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