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.
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), Presbyterian UltraFlex (HMO-POS), Presbyterian MediCare PPO, or Presbyterian Dual Plus (HMO D-SNP) 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.
Fax or Mail You, your doctor or pharmacist can also fax or mail an exception request.
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:
Login to myPres
Select Plan Information
First time users will be asked to create a HealthSafe ID account to keep personal health information safe. Please save your account information.
The next page is the Presbyterian “My Medicine Cabinet”
Select “Member tools” from the My Medicine Cabinet the tool bar
Select “Drug List Tool”
Select the link and follow the steps to submit a medication or reimbursement exception