About Coverage Determinations
You can ask Jefferson Health Plans for a coverage determination if the following apply:
- You need a drug that we don’t cover or need us to waive a rule or restriction we have on a drug in our formulary. Learn more about exceptions.
- You want us to cover a drug on our formulary and you believe you meet any rules or restrictions we have for this drug.
- You want us to pay you back for a drug you already got and paid for.
You, your prescriber or an authorized representative can make a request for a coverage determination or exception, and for exceptions, we also need a statement from your prescriber supporting your request.