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Web the information in this document is for the sole use of optum rx. Tier exceptions aren't available for. (1) dosage form(s) and/or dosage(s) tried; Tiers are the different cost levels you pay for a medication. Tier exceptions aren't available for drugs in the preferred generic tier. Web medical need for different dosage form and/or higher dosage [specify below: 2016 2nd edition 5 the information contained in this document is proprietary and confidential to optumrx. Web up to $40 cash back optumrx tier exception form is a request form that allows a patient to request a medication that is a higher tier on their insurance formulary. Covermymeds is optumrx prior authorization forms’s preferred method for receiving epa requests. Proper consent to disclose phi between these parties has been obtained. Web how to fill out and sign optumrx tier exception form medicare online?