You and your doctor can ask Horizon BCBSNJ to make an exception to cover a drug. If your doctor says that you have medical reasons to justify an exception, your doctor can help you request an exception. For example, you can ask the Horizon BCBSNJ to cover a drug even though it is not on your plan’s drug list, or you can ask the Horizon BCBSNJ to make an exception and cover the drug without restrictions.
Your doctor must submit a formulary exception or tier exception request form for approval. If the request is not approved by Horizon BCBSNJ, you can still purchase the medicine at your own expense.