Request a Medication Exception

As a BMC HealthNet Plan member, you can use the form below to submit a prior authorization request for a prescription that is not currently covered by your plan. Please fill out the full form and hit "Submit" at the end. To confirm whether a drug is currently covered please visit the Drug Finder for your plan type.  

Member Information
Requester Information, if not the Member
Provider Information
Drug Information

The text you enter here is displayed at the end of the form.

We're Here to Help

Contact Us