Request for Pharmacy/Formulary Exception = Pharmacy Prior Authorization
Members can initiate an exception for non – covered pharmaceuticals. Ventura County Health Care Plan’s (VCHCP) exception process for reviewing member requests for non - covered medications is through the Plan’s Utilization Management’s (UM)’s pharmacy prior authorization review.
If you would like to initiate an exception request for a non – covered medication, please complete the form below. A nurse will evaluate your request and call you within 2 business days. If you would like to speak directly with a nurse, please call 805-981-5060 and ask for a Utilization Management Nurse.
If you are experiencing a medical emergency, please dial 911. Always consult your physician about your individual healthcare needs and treatment options.
Pharmacy/Formulary Exception Request Form
First Name Last Name
Health Plan ID Number Member’s Date of Birth
Member’s Phone Number Member’s Email Address
Name and Dosage of Medication Name of Doctor Who Wrote Prescription
Doctor’s Phone Number
Please explain what exception is being requested and reason for requesting the exception.