What is a Coverage Determination Request?
A coverage determination request is a request to the patient’s drug plan for an exception to the plan’s standard formulary policy. Examples include requests for the plan to cover a drug that isn’t on the formulary, or to allow a patient to take a drug that requires advance approval from the plan for coverage. There are generally four types of Coverage Determination requests. You can read more about Prior Authorization, Quantity Limit, Step Therapy, Non-Formulary, and Tier requests.
