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Provider Manual

Formulary Exception Requests - Pharmacy Authorization Requests

Last Updated on August 28, 2018

Requests for a formulary exception review or an authorization for a drug restricted by utilization management can be initiated by contacting Security Health Plan Pharmacy Services, or by using the Security Health Plan interactive Provider Portal. Formulary exceptions will be considered if the drug requested is a substitute for a formulary drug and there is either documented clinical failure of the formulary alternative(s) in appropriate dosage regimens or if the member has a documented allergy, intolerance or medical contraindication to the use of the formulary alternative(s). Specific criteria for drugs requiring prior authorization is available online.

Exceptions for medications specifically excluded in the plan policy will not be granted.

Security Health Plan will respond to an authorization request as expeditiously as the medical condition requires, but no later than 15 calendar days.

Mail written requests to:
Security Health Plan
Attn: Pharmacy Benefits Specialist
P.O. Box 8000
Marshfield, WI 54449-8000

Providers or their agent(s) also may initiate requests for formulary exceptions or authorizations via:

  • Security Health Plan Pharmacy request line at 1-877-873-5611 or 715-221-9604 
  • Security Health Plan Pharmacy fax number at 715-221-9989 
  • Security Health Online (requires login with user name and password)