Bcbs Tier Exception Form - (1) formulary or preferred drugs contraindicated or tried. To submit request electronically, please go to. Web request for formulary tier exception [specify below: Web tier exception request form. Web send completed form to: Web you and your doctor can submit an exception request for drug coverage. (incomplete form may delay processing) please return completed form to: Web > secureblue (hmo) formulary exception and tier request form.
(1) formulary or preferred drugs contraindicated or tried. Web you and your doctor can submit an exception request for drug coverage. Web send completed form to: Web request for formulary tier exception [specify below: (incomplete form may delay processing) please return completed form to: Web > secureblue (hmo) formulary exception and tier request form. Web tier exception request form. To submit request electronically, please go to.