A medication shows "not covered." Don't kill the plan on the spot, don't tell the client it's impossible, and don't promise it'll eventually be covered.
1. Confirm medication is correct
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2. Confirm brand vs. generic
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3. Check formulary
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4. Check for a covered alternative
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5. Review step therapy / prior auth / quantity limits
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6. Explain the coverage determination process, if appropriate
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7. Never guarantee approval
PEAK coaching phrase
An exception is a process — not a promise.
Stay in your lane
Do not give medical advice, and never tell a beneficiary to change medications. That decision belongs between the beneficiary and their prescriber — your role is to explain the coverage process accurately, not to influence the medical choice.