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A type of Medicare prescription drug coverage determination. A formulary exception is a drug
plan’s decision to cover a drug that’s not on its drug list or to waive a coverage rule. A tiering
exception is a drug plan’s decision to charge a lower amount for a drug that’s on its
non-preferred drug tier. You or your prescriber must request an exception, and your doctor or
other prescriber must provide a supporting statement explaining the medical reason for the
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