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Pharmacy Exceptions

What if my drug is not on the Formulary?

If your drug is not included in the formulary (list of covered drugs), you should contact the Presbyterian Customer Service Center and ask if your drug is covered.
505-923-6060 or 1-800-797-5343 (TTY 711)
Hours: 8 a.m. to 8 p.m., 7 days a week

If you learn that our plan does not cover your drug, you have two options:

  • You can ask customer service for a list of similar drugs that are covered by our plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan.
  • You can ask Presbyterian Senior Care (HMO) or Presbyterian MediCare PPO to make an exception and cover your drug. Drug formulary exception can be requested by phone, fax, mail, or online.

How do I request a change?

Use one of the options below to submit a medication or reimbursement exception request. Send your request online at phs.org, or by phone or mail. The Presbyterian Pharmacy Services team will review your request.

Phone
To request an exception, you or your appointed representative should call Presbyterian Customer Service Center.
505-923-6060 or 1-800-797-5343 (TTY 711)
Hours: 8 a.m. to 8 p.m., 7 days a week


Fax or Mail
You, your doctor or pharmacist can also fax or mail an exception request.
Form Requesting Prior Authorization for Drugs
Fax: 505-923-5540
Mail: PHP Pharmacy Department
P.O. Box 27489
Albuquerque, NM 87125-7489


Online
To submit a medication or reimbursement exception request online:

  1. Login to myPRES
  2. Click “Access My Pharmacy.”
  3. First time users will be asked to create a HealthSafe ID account to keep personal health information safe. The next page is “My Medicine Cabinet”.
  4. Click “Member tools” on the tool bar.
  5. Click “Formulary” and follow the steps to submit a medication or reimbursement exception.

 

 


For information on Appeals and Grievances, click here

Last Updated: 10/15/2018