Pharmacy Formulary Exception Request

Prior Authorization

As a member of GHC-SCW, you may request coverage of a drug that requires prior authorization or is not on the formulary. Your request can be submitted through GHCMyChartSM or through your Primary Care Provider (PCP).

Submit Your Request Using GHCMyChart

Log into your GHCMyChartSM account. From the menu, choose "Meds & Orders” followed by “Drug Formulary.”  Select “Ask the Pharmacy” to send a message to GHC-SCW Pharmacy.

Please indicate the drug you are requesting, the medical reason for the medication and the name of your PCP. GHC-SCW Pharmacy Administration will contact your PCP for any medical information needed to consider your request.   

Submit Your Request Through Your Provider

Your PCP will need to complete a Formulary Exception Request Form by visiting,  Your prescriber will need to select "Prescribers" and login using their NPI number and state of practice. The Medication Prior Authorization Request form may be used when a drug-specific prior authorization form is not listed.

More Information

GHC-SCW Pharmacy Benefits
Phone (608) 828-4811
Mon. – Fri., 8 a.m. – 5 p.m

GHC-SCW Pharmacy Locations

Capitol Clinic Pharmacy

(608) 257-9732
Mon. - Fri., 8 a.m. - 7 p.m.
Sat. - Sun., 9 a.m. - 5 p.m.

Hatchery Hill Clinic Pharmacy

(608) 661-7242
Mon., Wed., Thurs. and Fri., 8 a.m. - 6 p.m.
Tues., 8 a.m. - 7 p.m.

Sauk Trails Clinic Pharmacy

(608) 257-4869
Mon., 8 a.m. - 7 p.m.
Tues. - Fri., 8 a.m. - 6 p.m.