If your physician or pharmacist tells you a drug is non-formulary or requires a tier exception, you may fill out a coverage determination form and SCAN will assist in having your physician send medical justification to Express Scripts to make a decision on whether to cover your request. Otherwise you may contact SCAN Member Services at 1-888-540-7226 (TTY Users: call 1-800-367-8939) for additional assistance in making this request.

A decision about whether SCAN will cover a non-formulary exception or tier exception can be a “standard” coverage determination that is made within the standard timeframe typically within 72 hours upon completed information. If incomplete information is given, the turnaround time will be delayed for up to 14 days. You may ask for a fast decision only if your physician believes that waiting for a standard decision could seriously harm your health or your ability to function.

Once a decision has been made, Express Scripts will send a letter to you and your physician regarding the decision of the coverage determination. To check the status of a coverage determination or exception, please contact Member Services at 1-888-540-7226