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Reformulary Group launches drug coverage exception process

Toronto, September 21, 2020 – Reformulary Group, an expert-led Canadian healthcare company, announced a new, independent service called myRequest™ to manage drug coverage exceptions, allowing plan members to submit a drug exception or appeal request if they have been declined coverage of their prescribed medications.

myRequest is a suite of services that includes reviewing drug coverage exception requests, requests for appeals, and other future services that are available through a user-friendly portal. The requests are then reviewed by Reformulary’s independent medical experts, who provide a recommendation.

myRequest was built based on feedback from Reformulary clients and other organizations. There was demand for both an exception and an appeal process that were independent from insurance companies and that used external medical experts to review requests.

The myRequest exception process or appeal process is available to any plan sponsor or plan administrator across the country, and is independent of the Reformulary, our evidence-based, managed formulary. Currently, a large Canadian association benefit plan is subscription to myRequest Services.

“Reformulary’s myRequest Services leverage what we do best,” said Helen Stevenson, CEO of Reformulary Group. “With the advice of our independent medical experts, we review each drug exception request based on best available evidence and make a decision specific to an individual.”

myRequest process

myRequest drug exception services includes a state-of-the-art, member-friendly portal that allows plan members to set up and access their account quickly and easily.

Once registered and signed into their account, members can fill out and upload the exception request form, reviewed and signed by their doctor. Additional documents supporting the request are also required. Reformulary’s medical experts then assess the request and make a recommendation to Reformulary Group, who ultimately makes the final decision on the exception request.

As a new development, myRequest Services will also include an appeal process for plan members that have already submitted a request and been denied coverage for a specific drug. Launching shortly, this service will initially be deployed with plan members of a large trust but is available to any plan sponsor or plan administrator in the Canadian market.

Evidence-based drug plans

The Reformulary is an evidence-based, managed formulary curated with the expert advice of an independent panel of doctors and pharmacists, which reviews massive amounts of research and evidence about drugs. Plans powered by Reformulary achieve significant savings and encourage members to make smart choices about the drugs they take. The Reformulary is widely used by Canadian employers and employees.

About Reformulary

Founded in 2011, Reformulary Group is an expert-led healthcare company focused on helping Canadians make sense of medicine. The company’s proprietary drug list, the Reformulary®, and award-winning DrugFinder™ digital tool provide Canadians with valuable comparative drug information, reviewed and vetted by an independent committee of doctors and pharmacists from across Canada. Reformulary Group built Cannabis Standard™, a discovery tool to guide medical cannabis use. Cannabis Standard also enables patients to search and compare products and to track the impact of medical cannabis on their quality of life using a survey tool recognized by healthcare professionals worldwide. For more information visit www.reformulary.com.