Formulary Change Notice
|
|
|
- Theresa Bruce
- 6 years ago
- Views:
Transcription
1 Formulary Change Notice HealthPartners may remove drugs from our formulary (list of covered drugs) or add rules about whether and when certain drugs are covered during the year. The chart below contains upcoming changes to the HealthPartners formulary. You may not be taking these drugs now. We provide you with these updates so that you know about future changes to our drug list. Please see Section 4 of your Monthly Prescription Drug Summary (Member Explanation of Benefits) for specific changes to drugs that you are currently taking. Effective Drug Type of Change Reason for Change Other Possible Drugs (if applicable) 02/13/2016 AUVI-Q 0.3MG/0.3 INJECTION AUTO FROM REMOVAL OF FROM DUE TO FDA ** EPIPEN AUTOINJECTOR - 3 INJCT MANDATED MARKET WITHDRAWAL 02/13/2016 AUVI-Q 0.15/0.15 INJECTION AUTO INJCT FROM REMOVAL OF FROM DUE TO FDA MANDATED MARKET ** EPIPEN JR AUTOINJECTOR /01/2016 EXELON 13.3MG/24H TRANSDERM. PATCH TD24 06/01/2016 AGGRENOX 25MG- 200MG CPMP 12HR WITHDRAWAL ** RIVASTIGMINE 13.3MG/24HR TRANSDERMAL PATCH - 2 ** ASPIRIN-DIPYRIDAMOLE 25MG-200MG ER /01/2016 VIRAMUNE XR 100 MG TAB ER 24H 06/01/2016 ORAP 2 MG 06/01/2016 SURMONTIL 100 MG ** NEVIRAPINE 100MG ER - 2 ** PIMOZIDE 2MG - 2 ** TRIMIPRAMINE 100MG - 2
2 06/01/2016 SURMONTIL 25 MG ** TRIMIPRAMINE 25MG /01/2016 TARGRETIN 75 MG ** BEXAROTENE 75MG /01/2016 ORAP 1 MG 06/01/2016 AVODART 0.5 MG 06/01/2016 GLEEVEC 100 MG 06/01/2016 GLEEVEC 400 MG 06/01/2016 PULMICORT 1 MG/2 ML INHALATION AMPUL-NEB 06/01/2016 INVEGA 3 MG TAB ER 24 ** PIMOZIDE 1MG - 2 ** DUTASTERIDE 0.5MG - 2 ** IMATINIB MESYLATE 100MG - 5 ** IMATINIB MESYLATE 400MG - 5 ** BUDESONIDE 1MG/2ML SUSPENSION FOR NEBULIZATION - 2 ** PALIPERIDONE 3MG ER /01/2016 INVEGA 6 MG TAB ER 24 ** PALIPERIDONE 6MG ER - 2
3 06/01/2016 INVEGA 9 MG TAB ER 24 ** PALIPERIDONE 9MG ER /01/2016 EXELON 9.5MG/24HR TRANSDERM. PATCH TD24 06/01/2016 EXELON 4.6MG/24HR TRANSDERM. PATCH TD24 06/01/2016 XENAZINE 25 MG 06/01/2016 XENAZINE 12.5 MG 06/01/2016 INVEGA 1.5 MG TAB ER 24 FROM FROM DUE TO ADDITION OF NEW ** RIVASTIGMINE 9.5MG/24HR TRANSDERMAL PATCH - 2 ** RIVASTIGMINE 4.6MG/24HR TRANSDERMAL PATCH - 2 ** TETRABENAZINE 25MG - 5 ** TETRABENAZINE 12.5MG - 5 ** PALIPERIDONE 1.5MG ER /01/2016 MEGACE ES 625MG/5ML SUSP ** MEGESTROL 625MG/5ML SUSPENSION /01/2016 MIRAPEX ER 4.5 MG TAB ER 24H ** PRAMIPEXOLE 4.5MG ER - 2
4 06/01/2016 SURMONTIL 50 MG ** TRIMIPRAMINE 50MG /01/2016 MIRAPEX ER 2.25 MG TAB ER 24H ** PRAMIPEXOLE 2.25MG ER /01/2016 MIRAPEX ER 3 MG TAB ER 24H ** PRAMIPEXOLE 3MG ER /01/2016 MESTINON 180 MG ER 06/01/2016 JALYN MG CPMP 24HR 06/01/2016 NDA 10 MG ** PYRIDOSTIGMINE 180MG ER - 2 ** DUTASTERIDE-TAMSULOSIN 0.5MG-0.4MG ER - 2 ** MEMANTINE 10MG /01/2016 NDA 5 MG 06/01/2016 NDA 5 MG-10 MG TAB DS PK 06/01/2016 NDA 2 MG/ML SOLUTION 06/01/2016 LOTRONEX 0.5 MG ** MEMANTINE 5MG - 2 ** MEMANTINE 5MG-10MG S IN A DOSE PACK - 2 ** MEMANTINE 2MG/ML SOLUTION - 2 ** ALOSETRON 0.5 MG - 5
5 06/01/2016 SODIUM CITRATE AND NDC FROM ** SHOHL'S MODIFIED MG SOLUTION - 1 CITRIC ACID MG SOLUTION 06/01/2016 CYTRA MG SOLUTION NDC FROM ** SHOHL'S MODIFIED MG SOLUTION /01/2016 ABILIFY DISCMELT 10 MG TAB RAPIDS 06/01/2016 ABILIFY DISCMELT 15 MG TAB RAPDIS 06/01/2016 POTASSIUM CITRATE-CITRIC ACID PACKET 06/01/2016 LOTRONEX 1 MG 08/01/2016 SODIUM FLUORIDE 0.20% DENTAL SOLUTION NDC FROM NDC FROM ** ARIPIPRAZOLE 10 MG DISINTEGRATING - 2 ** ARIPIPRAZOLE 15 MG DISINTEGRATING - ** POTASSIUM CITRATE 5 MEQ, 10 MEQ OR 15 MEQ ER - 2 ** ALOSETRON 1 MG - 5 ** DENTA 5000 PLUS 1.1% DENTAL CREAM /01/2016 VITAPEARL CAP IR DR NDC FROM ** VITATRUE COMBO. PKG /01/2016 PRENA1 CHEW 1.4 MG TAB CH BPH NDC FROM ** VITAMEDMD REDICHEW RX 1.4 MG TAB CH BPH - 1
6 08/01/2016 PRENAISSANCE DHA MG COMBO. PKG NDC FROM ** CITRANATAL DHA MG COMBO. PKG /01/2016 PRENATABS RX 29 MG-1 MG 08/01/2016 TRINATE 28 MG-1 MG 08/01/2016 VINATE-M 27 MG-1 MG 08/01/2016 VINATE ONE 60 MG- 1 MG NDC FROM NDC FROM NDC FROM NDC FROM ** PRENATAL PLUS 29 MG-1 MG - 1 ** VIRT-NATE 28 MG-1 MG - 1 ** PRENATAL LOW IRON 27 MG-1 MG - 1 ** POLY IRON PN 60 MG-1 MG /01/2016 ICAR-C PLUS NDC FROM ** FE C PLUS ** This drug is on our drug list (formulary). Please talk with your doctor to find out if this drug is right for you. Note: The amount you will pay for this drug depends on which coverage period you are in. You can call Member Services to find out how much you will pay for this drug. HealthPartners MSHO is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. HealthPartners Freedom and HealthPartners Retiree National Choice are offered by HealthPartners, a Cost plan and a PDP with a Medicare Contract. Enrollment in HealthPartners depends on contract renewal.
7 What you and your doctor can do We are telling you about these changes now, so that you and your doctor will have time (at least 60 days) to decide what to do. Depending on the type of change, there may be different options to consider. For example: Perhaps you can find a different drug covered by the plan that might work just as well for you. o You can call us at HealthPartners Member Services to ask for a list of covered drugs that treat the same medical condition. o This list can help your doctor to find a covered drug that might work for you and have fewer restrictions or a lower cost. You and your doctor can ask the plan to make an exception for you. This means asking us to agree that the upcoming change in coverage or cost-sharing tier of a drug does not apply to you. o Your doctor will need to tell us why making an exception is medically necessary for you. o To learn what you must do to ask for an exception, see the Evidence of Coverage that we sent to you. Look for Chapter 9, What to do if you have a problem or complaint. o (Section 6 of your Monthly Prescription Drug Summary tells how to get a copy of the Evidence of Coverage if you need it.) For more information To get updated information about the drugs covered by HealthPartners please visit our Web site at or call Member Services at (Freedom and Retiree National Choice) or (MSHO) or toll free at (Freedom and Retiree National Choice) or (MSHO) from 8 a.m. to 8 p.m., seven days a week from October 1 through February 14, or from February 15 through September 30 call us 8 a.m. to 8 p.m. Monday through Friday to speak with a representative. Calls to these numbers are free. TTY/TDD users should call or toll free at If you disagree with our decision to remove or change coverage for any of these drugs, you may also file a grievance with us. Please call us at HealthPartners Member Services if you want to file a grievance. You may also send your grievance to us in writing to HealthPartners Member Rights & Benefits PO Box 9463 Minneapolis, MN For more information on filing a grievance, look for Chapter 9, What to do if you have a problem or complaint. This document may be made available in other formats such as Braille, large print or other alternate formats. Please call Member Services at [ ] [ ] or toll free at [ ] [ ] for additional information. TTY users should call or toll free at We are available from 8 a.m. to 8 p.m., seven days a week from October 1 through February 14, or from February 15 through September 30 call us 8 a.m. to 8 p.m. Monday through Friday to speak with a representative. For more detailed information about your HealthPartners prescription drug coverage, please review your Evidence of Coverage and other plan materials.
8 If you have general questions about Medicare prescription drug coverage, please call Medicare at MEDICARE ( ) 24 hours a day/7 days a week. TTY/TDD users should call Or, visit Medicare s Extra Help Program You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: MEDICARE ( ). TTY users should call , 24 hours a day/ 7 days a week; The Social Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, ; or Your Medicaid Office. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. The formulary, may change at any time. You will receive notice when necessary.
2016 FORMULARY ADDENDUM NOTICE OF CHANGE
2016 FORMULARY ADDENDUM NOTICE OF CHANGE (PRESCRIPTION DRUG PLANS) WELLCARE PRESCRIPTION INSURANCE, INC. WellCare Simple (PDP) WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes
Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) 2017 Drug List
Upcoming Changes to Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) 2017 Drug List Updated 8/1/2017 Santa Clara Family Health Plan (SCFHP) Cal MediConnect Plan (Medicare-Medicaid
Medicare Part D 2016 Formulary Changes Service To Senior and OC Preferred
Medicare Part D 2016 Formulary s Service To Senior and OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior
Medicare Part D 2016 Formulary Changes Desert Preferred Choice
Medicare Part D 2016 Formulary s Desert Preferred Choice Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
2019 Drug List Negative Changes
2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions
2019 Formulary Update
MEDICARE ADVANTAGE BlueShield of Northeastern New York Formulary Update BlueShield of Northeastern New York has updated its formulary (drug list) since its original publication in January. This document
Network Health Insurance Corporation Upcoming Negative Changes to the Medicare Part D Formulary
Requesting an Exception to the Formulary You can ask Network Health Insurance Corporation to make an exception to our coverage rules. Generally, we will only approve your request for an exception if alternative
2019 Drug List Negative Changes
2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions
2018 Formulary Notice of Change Prescription Drug Plans
2018 Formulary Notice of Change Prescription Drug Plans WellCare Prescription Insurance, Inc. Plans in all states: WellCare Classic (PDP) WellCare may add or remove drugs from our formulary during the
WellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum
WellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum This is a listing of the changes that have occurred in our formulary. Please carefully review these changes and call WellCare if you
Medicare Part D 2016 Formulary Changes Service To Senior and OC Preferred
Medicare Part D 2016 Formulary s Service To Senior and OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior
Changes to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies
Changes to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies BlueCross BlueShield of South Carolina may add or remove drugs from the formulary during the year. If we remove drugs
DRUG CLASSIFICATION. Prevention of Cardiovascular Disease
Generic Preventive Care/ Safe Harbor Drug Program List Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition.
2016 Step Therapy (ST) Criteria
2016 Step Therapy (ST) Some drugs require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a drug that
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax:
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Fax Number: Anthem Blue Cross Cal MediConnect Plan 1-844-493-9213 Medicare Prior Authorization
MEMBER GRIEVANCES AND APPEALS PROCEDURES
MEMBER GRIEVANCES AND APPEALS PROCEDURES We value our members. We want you to let us know right away if you are not happy with our health plan. This includes if you have any questions, complaints or problems
Additional Drug Coverage
Additional Drug Coverage Additional prescription drug coverage Your plan includes extra coverage for certain supplies as shown below. These supplies are either not generally covered under Medicare Part
Pharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS
Workforce Safety & Insurance Revised Document Date: 07/21/2015 1600 E Century Ave Ste 1 PO Box 5585 Bismarck, ND 58506-5585 701.328.3800 1.800.777.5033 www.workforcesafety.com Pharmacy Benefit Management
HOW TO USE THE FORMULARY
INTRODUCTION The information contained in the Willamette Valley Community Health (WVCH) WRAP/D-Excluded Formulary and its appendices is provided solely for the convenience of medical providers. WVCH does
2017 Formulary Addendum Notice of Change (Prescription Drug Plans)
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Golden State Medicare Health Plan, Golden (HMO) Last Updated: 09/01/2018
Step Therapy Golden State Medicare Health Plan, Golden (HMO) Last Updated: 09/01/2018 ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG
Thank you for being a Premera Blue Cross Medicare Supplement plan member.
P.O. Box 327 Seattle, WA 98111 February 18, 2019 MSF1 Dear : Thank you for being a Premera Blue Cross Medicare Supplement plan member. The rate table on the next page shows the following rate information:
2015 Step Therapy (ST) Criteria
2015 Step Therapy (ST) Some drugs require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a drug that
Generic Preventive Care/ Safe Harbor Drug Program List
Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition. The Generic Preventive Care/Safe Harbor Drug Program
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Freedom Plan (HMO SNP) H5087-001 This is a listing of the changes that have occurred in our formulary.
2018 Step Therapy Criteria (List of Step Therapy Criteria)
Step Therapy Criteria Last Updated: March 20, 2018 Effective Date: April 1, 2018 2018 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP DUALCHOICE CAL MEDICONNECT PLAN (MEDICARE-MEDICAID
$250 (Deductible does not apply to Tier 1 and Tier 2) $500 (Deductible does not apply to Tier 1 and Tier 2)
Benefit Summary Outpatient Prescription Drug Illinois 5/50/100/250 Plan 455 Your Co-payment and/or Co-insurance is determined by the tier to which the Prescription Drug List (PDL) Management Committee
Healthy Michigan Dental Plan Handbook
Healthy Michigan Dental Plan Handbook Contents 1. Welcome 2. Definitions 3. How to Use Healthy Michigan Plan 4. What Healthy Michigan Plan Covers 5. Questions and Answers 6. Grievances and Appeals 7. General
Additional Drug Coverage
Additional Drug Coverage Bonus Drug List Your employer group or plan sponsor offers a bonus drug list. The prescription drugs on this list are covered in addition to the drugs on the plan s drug list (formulary).
HMO INSERT TO 2019 EVIDENCE OF COVERAGE
Optima Medicare HMO INSERT TO 2019 EVIDENCE OF COVERAGE Chapter 4, Section 2.2 on Extra optional supplemental benefits you can buy Dental Optional Supplemental Benefits Optima Medicare offers some extra
Additional drug coverage
Additional drug coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs as shown below. These drugs are either not generally covered under Medicare Part D or
Effective for all members on November 1, 2017
November 2017 Pharmacy Formulary Change Notice BlueChoice HealthPlan Medicaid is here to help you stay on top of your health care. We want to tell you about some upcoming changes to your Preferred Drug
2011 Formulary Addendum
2011 Formulary Addendum This is a listin of the chanes that have occurred in our formulary. Please carefully review these chanes and call WellCare if you have any questions. Date of Chane: 03/01/2011 Formulary
2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) WellCare Health Plans WellCare Access (HMO SNP), WellCare Liberty (HMO SNP), WellCare Reserve (HMO), WellCare Rx (HMO), WellCare Select
2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
New Generics: Specialty Network: Retail Pharmacies Dispensing Specialty Products
SUPPORTING OUR PROVIDER PARTNERS THROUGH COMMUNICATION AND COLLABORATION. DATE JANUARY 2016 ISSUE 1 HELPFUL NUMBERS FOR PROVIDERS Magellan: 1-800-846-7971 Bin: 016523 Processor control: 747 HELPFUL NUMBERS
2018 STEP THERAPY CRITERIA UCare Connect (SNBC) MinnesotaCare Prepaid Medical Assistance Program (PMAP) Minnesota Senior Care Plus (MSC+)
2018 STEP THERAPY CRITERIA UCare Connect (SNBC) MinnesotaCare Prepaid Medical Assistance Program (PMAP) Minnesota Senior Care Plus (MSC+) In some cases, UCare requires you to first try certain drugs to
MEMBER GRIEVANCE/COMPLAINT FORM. Address City State Zip Code
MEMBER GRIEVANCE/COMPLAINT FORM Date: Please print all information. Complainant information: ( ) ( ) Name Work Telephone Number Home Telephone Number Address City State Zip Code Name of person(s) related
Affordable dental plan options for Blue Shield members
Affordable dental plan options for Blue Shield members January 1 December 31, 2018 Blue Shield offers two optional supplemental dental plans to Blue Shield 65 Plus SM (HMO), Blue Shield 65 Plus Choice
Step Therapy Criteria
Tier 5 Formulary Step Therapy 2016 Updated: 05/24/2016 Effective: 06/01/2016 What is Step Therapy? Some prescription drugs require step therapy (ST). In some cases, the plan requires you to first try certain
Spring 2018 Health and Wellness Newsletter
Spring 2018 Health and Wellness Newsletter Check out what Molina offers online Have you logged in to the Molina website lately? You have many resources to help you learn more about how Molina works. One
Community Health Plan of Washington and You Medical Care Services
Community Health Plan of Washington and You Medical Care Services with Community Health Plan of Washington Including: About Community Health Plan of Washington Your Enrollment New TTY number Eligibility
Amy Larrick Chavez-Valdez, Director, Medicare Drug Benefit and C & D Data Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE TO: FROM: SUBJECT: All Part D Sponsors Amy Larrick
2018 STEP THERAPY CRITERIA UCare Connect (SNBC) MinnesotaCare Prepaid Medical Assistance Program (PMAP) Minnesota Senior Care Plus (MSC+)
2018 STEP THERAPY CRITERIA UCare Connect (SNBC) MinnesotaCare Prepaid Medical Assistance Program (PMAP) Minnesota Senior Care Plus (MSC+) In some cases, UCare requires you to first try certain drugs to
DIRECTORY Pharmacy
2017 Pharmacy DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
2014 Quantity Limits (QL) Criteria
2014 Quantity Limits (QL) Criteria Certain drugs covered through your EmblemHealth Medicare HMO/PPO Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food
DIRECTORY. UnitedHealthcare MedicareRx for Groups (PDP)
2015 Pharmacy DIRECTORY UnitedHealthcare MedicareRx for Groups (PDP) This directory is a partial list of network pharmacies near you. This directory is for Northern Mariana Islands. For more information,
Medicare Part D Opioid Policies for 2019 Information for Patients
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Part D Opioid Policies for 2019 Information for Patients Introduction Prescription opioid pain medications like oxycodone (OxyContin ), hydrocodone (Vicodin
2018 Step Therapy (ST) Criteria
2018 Step Therapy (ST) Criteria Some drugs require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a
2018 Step Therapy Criteria (List of Step Therapy Criteria)
Criteria Last Updated: October 05, 2017 Effective Date: January 1, 2018 2018 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP DUALCHOICE CAL MEDICONNECT PLAN (MEDICARE-
2019 List of Covered Drugs
2019 List of Covered Drugs Formulary ID: 19391 Version 10 Updated: 02/2019. If you have questions, please call First Choice VIP Care Plus at 1-888-978-0862 (TTY 711), seven days a week, 8 a.m. to 8 p.m.
Additional drug coverage
Additional drug coverage Bonus Drug List Your plan sponsor (employer, union or trust) offers a bonus drug list. The prescription drugs on this list are covered in addition to the drugs on the plan s drug
DIRECTORY Pharmacy
2017 Pharmacy DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
2018 Medicare Part D Formulary Change
2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
Drugs That Require Step Therapy (ST)
Saver Drugs That Require Step Therapy (ST) In some cases, Express Scripts Medicare (PDP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that
2019 PHARMACY DIRECTORY
2019 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
You ll find the most up-to-date comprehensive version of our formulary on our website, Click on Drug Finder.
3/1/2018 Medicare Part D Formulary Change In an effort to cover the most needed, cost-effective prescriptions, the AlohaCare Advantage Plus (HMO SNP) Formulary is updated monthly. The following are drugs
2018 PHARMACY DIRECTORY
2018 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
Additional Drug Coverage
Additional Drug Coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs and supplies as shown below. These drugs are either not generally covered under Medicare
Medication Therapy Management program
Medication Therapy Management program Your one-on-one review of your medicines Be safe Feel good Save money Safe and sound never felt so good Get the most from your medicine therapy with a personal medicine
2018 Formulary Update
MEDICARE ADVANTAGE BlueShield of Northeastern New York 2018 Formulary Update BlueShield of Northeastern New York has updated its formulary (drug list) since its original publication in January 2018. This
Drugs That Require Step Therapy (ST)
Choice Drugs That Require Step Therapy (ST) In some cases, Express Scripts Medicare (PDP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that
Drug Formulary Update, January 2017 Commercial and State Programs
Drug Formulary Update, January 2017 Commercial and State Programs Updates to the HealthPartners Commercial and State Program Drug Formularies are listed below. Updates apply to all Commercial groups (PreferredRx,
Drugs That Require Step Therapy (ST)
Saver Drugs That Require Step Therapy (ST) In some cases, Express Scripts Medicare (PDP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that
2019 Supplemental Drug List
2019 Supplemental Drug List This supplemental drug list was updated on August 2018. For more recent information or other questions, please contact Blue Cross Medicare Advantage Customer Service, at 1-877-299-1008
Managed Health Services (MHS) Candace V. Ervin Market Manager, Indiana Provider Relations October 18, 2017
Managed Health Services (MHS) Candace V. Ervin Market Manager, Indiana Provider Relations Candace.Ervin@Envolvehealth.com October 18, 2017 1 Today s Agenda MHS ID Card Samples Provider Visits D1110 (Prophylaxis
Pharmacy Medical Necessity Guidelines: Atypical Antipsychotic Medications. Effective: February 20, 2017
Pharmacy Medical Necessity Guidelines: Effective: February 20, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED)
Health TALK. Take charge. Health4Me TM. Prepare to see your provider.
Health TALK SPRING 2018 Health4Me TM Do you have the UnitedHealthcare Health4Me mobile app? Health4Me has many of the same features as your secure member website, myuhc.com/communityplan. You can view
Health Partners Medicare Prime 2019 Formulary Changes
Health Partners Medicare Prime 2019 Formulary Changes Changes occur, for example, because new drugs come on the market, a drug is moved to a different cost-sharing level (tier), or a generic version becomes
Drug Formulary Update, January 2013
Drug Formulary Update, January 2013 Updates to the HealthPartners Drug Formularies are listed below. Updates for the Commercial Drug Formularies and the Minnesota Health Care Programs (Medicaid and Minnesota
Pharmacy Medical Necessity Guidelines: Atypical Antipsychotic Medications. Effective: December 12, 2017
Pharmacy Medical Necessity Guidelines: Effective: December 12, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED)
Aspirin. Iron Supplements
Interim Final Rules for Non-Grandfathered Group Health Plans and Health Insurance Issuers Coverage of Preventive Services Under the Patient Protection and Affordable Care Act Aspirin Aspirin to Prevent
2018 Medicare Part D Formulary Change
2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
2018 PHARMACY DIRECTORY
2018 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
Additional DRUG COVERAGE
Additional DRUG COVERAGE Bonus Drug List Your plan sponsor (employer, union or trust) offers a bonus drug list. The prescription drugs in this list are covered in addition to the drugs in the plan s formulary
2018 PHARMACY DIRECTORY
2018 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
Total Care Bulletin Welcome to the Magellan Complete Care Florida newsletter.
WINTER 2016 Total Care Bulletin Welcome to the Magellan Complete Care Florida newsletter. This newsletter is from your health plan, Magellan Complete Care. It has important information about getting and
Antipsychotic Medications Age and Step Therapy
Market DC *- Florida Healthy Kids Antipsychotic Medications Age and Step Therapy Override(s) Approval Duration Prior Authorization 1 year Quantity Limit *Virginia Medicaid See State Specific Mandates *Indiana
Evidence of Coverage Rider for Enrollees who are enrolled in the Freedom Comprehensive Dental Benefit
Evidence of Coverage Rider for Enrollees who are enrolled in the Freedom Comprehensive Dental Benefit Please keep this notice as it is part of your HealthPartners Freedom Balance with Rx (Cost)/HealthPartners
Quarterly pharmacy formulary change notice
Provider Bulletin October 2018 Quarterly pharmacy formulary change notice The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. The changes listed in the table
Coverage Period: 01/01/ /31/2018 Coverage for: Individual and/or Family Plan: Healthy Rewards HSA
This is only a summary of your GatorCare pharmacy benefits. If you would like detail about your coverage and costs, you can get the complete terms in the policy or plan document at gatorcare.magellanrx.com/member
2018 Preventive Schedule
2018 Preventive Schedule Medicare-Covered Services PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat.
2014 Rates. About Delta Dental networks BENEFITS OVERVIEW. Employee Only: $ Employee & Spouse: $ Employee & Child(ren): $83.
BENEFITS OVERVIEW Benefit Summary for: Denny s, Inc. Effective Date: January 1, 2014 Plan Option: HIGH PLAN Delta Dental PPO Dentacare M Delta Dental PPO & Premier Non- Participating Providers Part-Time
Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS INSURANCE GROUP
EOC #82 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS
Additional DRUG COVERAGE
Additional DRUG COVERAGE Lower-cost Medicare prescription drugs Your plan covers some of your Medicare prescription drugs and supplies at a lower drug tier or co-pay than in your formulary (drug list).
Additional drug coverage
Additional drug coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs as shown below. These drugs are either not generally covered under Medicare Part D or
Quarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice Provider update Summary: The formulary changes listed in the table below were reviewed and approved at our second quarter 2018, Pharmacy and Therapeutics Committee
VitalityFALL Be sure to check inside for upcoming Viva Medicare Plus Fall Health Fair dates! Your 2012 Viva Medicare Plus Benefits
VitalityFALL 2011 Viva A newsletter for Viva Medicare Plus members. Your 2012 Viva Medicare Plus Benefits Viva Medicare Plus, a Medicare Advantage plan, has a yearly contract with the Centers for Medicare
Neighborhood Medicaid Formulary Changes: June 2017
Neighborhood Medicaid Formulary Changes: June 2017 The following changes to the Neighborhood Medicaid Formulary were recently approved by the Pharmacy and Therapeutics (P&T) Committee. All changes were
Individual Select Preferred Dental
Individual Select Preferred Dental District of Columbia Change to Individual Select Preferred District of Columbia Applicants Beginning on October 1, 2011, all participating dentists, dental specialists,
2018 PHARMACY DIRECTORY
2018 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
DIRECTORY. UnitedHealthcare MedicareRx for Groups (PDP)
2015 Pharmacy DIRECTORY UnitedHealthcare MedicareRx for Groups (PDP) This directory is a partial list of network pharmacies near you. This directory is for Guam. For more information, please call Customer
Coverage Period: Coverage for: Plans: This is only a summary of your GatorCare pharmacy benefits. Coinsurance: you your Dependent Copayment: you
This is only a summary of your GatorCare pharmacy benefits. If you would like detail about your coverage and costs, you can get the complete terms in the policy or plan document at gatorcare.magellanrx.com/member
HealthyYou. Silver&Fit Exercise & Healthy Aging Program. Something for Everyone! Preferred Pharmacies page 3. Annual Physical Exams page 7
Satisfaction Surveys page 2 Preferred Pharmacies page 3 Annual Physical Exams page 7 HealthyYou Winter 2016 Silver&Fit Exercise & Healthy Aging Program. Something for Everyone! With the Silver&Fit program,
IlliniCare Health MMAI (MMP) 2016 Step Therapy Criteria
IlliniCare Health MMAI (MMP) 2016 Step Therapy Criteria Instructions: 1. With this file, at the top, click Edit, then click Find. 2. In the Find box type the name of the medication you want to find. 3.
2014 Step Therapy Criteria (List of Step Therapy Criteria)
Criteria Last Updated: November 1, 2014 2014 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP MEDICARE DUALCHOICE (HMO SNP) REQUIRES YOU TO FIRST TRY CERTAIN DRUGS TO TREAT