← Glossary · CMS & regulatory
Exception request
A coverage determination asking for an exception, such as a tiering, non-formulary, formulary UM, hospice or safety edit exception.
Exception requests are reported in Universe Table 2 (CDER), not Table 1. The decision clock runs from receipt of the prescriber's supporting statement: 72 hours for standard and 24 hours for expedited requests. If no supporting statement arrives within 14 calendar days, the clock runs from the end of those 14 days.
Source: CDAG protocol, Timeliness 1.3-1.4, p. 5; Universe Table 2, Column T, p. 27.