What should be done if a member's drug is not listed in the provided formulary?

In the situation where a member's drug is not listed in the provided formulary, contacting customer support for clarification is the most appropriate action. Customer support is equipped with the latest information regarding covered medications and can assist in determining if the drug is eligible for coverage under different circumstances or possibly guide the member through available alternatives. This approach ensures that the member receives accurate information and assistance tailored to their specific needs.

Other options may not address the complexity of such situations effectively. Assuming a drug is not covered without further inquiry could lead to misinformation and unmet health needs. Consulting with a healthcare provider might be a helpful step but does not directly address the uncertainty regarding formulary coverage. Asking the member to find alternatives places the burden on them for a solution rather than acting as a supportive navigational resource. Therefore, the most proactive step is to engage with customer support to find the best resolution.