FOR PRESCRIBERS ONLY: Please prescribe formulary medication(s) for your patients with Kaiser Permanente benefits. If a formulary medication is not appropriate, complete the Drug Coverage Request form (PDF) and fax to 1-866-618-6569.
Drugs not listed on the formulary, known as nonformulary drugs, aren’t covered by your plan. If your doctor decides that a nonformulary drug is medically necessary, your doctor can request an exception. With an exception, the drug will be covered by your prescription drug benefit — if your plan has one. Without an exception, you’ll be charged the full retail price for the drug.
The most effective way to get an exception to the formulary is to send a secure email to your doctor.
You can also contact Membership Services by submitting an online form. Or you can call us, Monday through Friday, 8 a.m. to 6 p.m. at:
Portland area: 1-503-813-2000
All other areas: 1-800-813-2000
TTY Oregon : 1-800-735-2900
TTY Washington: 711
Language interpretation services: 1-800-324-8010
If you want a nonformulary drug that your doctor doesn’t believe to be medically necessary, you can file a grievance (Senior Advantage and Medicare Cost members can file a coverage determination). To start the process, call Membership Services at the numbers above.