Minnesota Uniform Formulary Exception Form

Please note the following changes:

Minnesota 2009 Session Laws, Chapter 79, Article 4, Sec. 4 required the Minnesota Department of Health (MDH), to develop a “uniform formulary exception form”.  MDH consulted with the Minnesota Administrative Uniformity Committee (AUC) and interested parties in developing and making available the Minnesota Uniform Formulary Exception Form (UFEF) in mid-2009.  The UFEF was very similar to another form that MDH also developed in consultation with the AUC and the industry, for prescription drug Prior Authorization (PA) requests.  Because of the similarities between the two forms, MDH has created a single, combined UFEF and prescription drug PA request form:  the Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions.  This single, combined form supersedes all previous versions of the UFEF.

Please also note:

  • This Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions is intended for use by health care providers and group purchasers (payers).  Please do not  submit completed forms to the Minnesota Department of Health.
  • The Form is the single form to be used by health care providers to request exceptions from group purchaser (payer) formularies. 
  • All health care providers must submit requests for formulary exceptions using the form, and all group purchasers must accept the form from health care providers.
  • Group purchasers may request additional information or clarification to ensure that formulary exception requests are processed as accurately and efficiently as possible.
  • Group purchasers are also encouraged to respond to the formulary exception request using a particular section (“Section G”) of the form.
  • Group purchasers may supply additional instructions or other relevant or legally required information with their response.
  • No later than January 1, 2011, the form must be accessible and submitted by health care providers, and accepted and processed by group purchasers, through secure electronic transmissions. As a result of Minnesota Laws, Chapter 336, Sec. 4, facsimile is now considered a form of electronic transmission for the purpose of transmitting formulary exception requests.

Link to Adobe Acrobat Reader To view the PDF files, you will need Adobe Acrobat Reader (free download from Adobe's website).

Updated Tuesday, November 16, 2010 at 12:30PM