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The medication you seek an exception for will initially be reviewed by our pharmacy benefit manager, OptumRx. Initial requests for formulary exception are reviewed within 24 hours for expedited requests and 72 hours for standard requests. To request an expedited review for emergency circumstances, indicate that you need memorial health family medicine expedited or urgent review on the request form or verbally if initiating the request marketplace helath phone.

If the drug is denied, you have the right to an external review. If you feel we have denied the non-formulary request incorrectly, you memorial health family medicine ask us to submit the case to an external review by memodial impartial, third-party reviewer known as an Independent Review Organization IRO.

We click at this page follow the IRO's decision. An IRO review may be requested by a member, member's representative, or prescribing provider by mailing, calling or faxing the request:.

Note: The member or the member's legal guardian must sign the consent to release medical information to the IRO medivine as part of IRO form.

The URA will comply with the Independent Review Organization's determination with respect to the medical necessity or appropriateness of healthcare items and services, and the experimental or investigational nature memorial health family medicine healthcare items and services for an enrollee.

To request an expedited external review for exigent circumstance, indicate the request is for urgent care on the Request Form or verbally if initiating the request by phone.

For standard exception review of medical requests where request was denied, the timeframe for review is 72 hours from when we receive medcine request.

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