
- If the patient has already tried and failed the insurer-preferred drug
- If delayed treatment will cause irreversible consequences
- If requiring the insurer-preferred drug will cause harm to the patient
- If the required drug will prevent a patient from working or fulfilling activities such as eating, grooming, dressing, bathing and other Activities of Daily Living as defined by the Centers for Medicare and Medicaid Services (CMS)
- If the patient is stable on the prescription drug selected by their provider, and that drug has been covered by their previous insurance plan.