Medicare Advantage Plans
    Shop for Plans
    For Members
myPRES Login
Attend Seminar
Request Info Kit
Contact Us
Prescription Drugs
Pharmacy Exceptions


  • Forms, Plan Information, Policies
  • Provider Directory
  • Appeals and Grievances
  • Request Pharmacy exception
  • Fraud and Abuse
  • Form for Medicare Complaint
  • Nondiscrimination
Last Updated: 10/1/2023

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.

 or  (TTY ) Hours: 8 a.m. to 8 p.m., Sunday - Saturday

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, 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.

 or  (TTY ) Hours: 8 a.m. to 8 p.m., Sunday - Saturday

Fax or Mail You, your doctor or pharmacist can also fax or mail an exception request.

Form for Medicare Drug Coverage Determination Request

Form for Presbyterian Dual Plus (HMO D-SNP) Drug Coverage Determination 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:

  1. Login to myPres

  2. Select Plan Information

  3. Select Prescriptions

  4. First time users will be asked to create a HealthSafe ID account to keep personal health information safe. Please save your account information.

  5. The next page is the Presbyterian “My Medicine Cabinet”

  6. Select “Member tools” from the My Medicine Cabinet the tool bar

  7. Select “Drug List Tool”

  8. Select the link and follow the steps to submit a medication or reimbursement exception

For information on Appeals and Grievances, click here