Formulary exceptions are requests by members or their authorized representatives to obtain a pharmaceutical that is not included as part of the organization’s closed formulary. Requests for lower co-pays, vacation supplies, or early refills are not valid exceptions and therefore will not be reviewed. Certain medications may be excluded by your plan’s prescription rider or plan contract.

Submitting a Request

Please complete the form below and select Submit to send your request. The information will be sent securely to protect your privacy. Use the web browser print function if you would like to print a copy of this request for your records.

Allow up to 72 hours for MVP to process your request. MVP may require additional clinical information from your physician to process this request. The time frame for the review of this request will begin when MVP receives this information.