This comprehensive formulary is a complete list of the drugs covered by our plan. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription. Most other prescription drugs are on the formulary including specialty medications. Food and drug administration fdaapproved prescription medications.
The medications listed on this formulary are subject to change pursuant to the formulary management activities of optum. This document contains information about the drugs we cover in this plan this formulary was updated on 06282016. To get updated information about the drugs covered by our plan, please contact us. Golden rule insurance company prescription benefits unitedhealthcare wants you to get the most out of your pharmacy benefit. Healthfirst medicaid managed care and child health plus formulary.
This document contains information about the drugs we cover in this plan formulary id 00016397, version 8 this formulary was updated on 08192015. This document contains information about the drugs we cover in this plan this formulary was updated on 05262016. Please use the following link to find additional information on the pennsylvania medical assistance program preferred drug list pdl includes pdf of dhs pdl. Includes a printable bracket and links to buy ncaa championship tickets. Visit locate a participating retail pharmacy by zip code. This document contains information about the drugs we cover in this plan hpms approved formulary file submission id 17488, version number 15 this formulary was updated on 05232017. An important part of the pdl is giving you choices so you and your doctor can choose the best course of treatment for you. Call the tollfree member phone number on your health plan id card. Our contact information appears on the front and back cover pages. Visit or locate a participating retail pharmacy by zip code. Our contact information, along with the date we last updated the formulary, is on the cover.
Please understand that this formulary is not intended as a substitute for a providers independent, professional judgment. If you have questions about keystone first, please call member services at 18005216860, tty users should call 18006845505. This formulary is a list of prescription medications that are covered under optimum healthcare, inc. The premium formulary is considered partiallyclosed because it excludes coverage of some brandname drugs that do not offer a clear clinical advantage over other less costly brand or generic alternatives. A formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers. A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Prescription drug program formulary prior auth required prescription drug program formulary. Keystone first will also cover additional medications that are not on the dhs pdl as a part of our supplemental formulary.
Products not listed on the formulary are generally not covered. If we remove drugs from our formulary, or add prior authorization, quantity limits andor step therapy restrictions on a drug or move a drug to a higher costsharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the. Using this formulary reference guide to help contain costs many health plans use the formulary to help manage the overall cost of providing prescription drug benefits. Speak with your pharmacist to have your excluded brandname medication substituted with its generic equivalent. Formulary 2016 pharmacy tar submission providers submitting pos claims through medimpact. A formulary identifies the drugs available for certain conditions and organizes them. Basic formulary preferred drug list 2017 page 2 specialty drugs these drugs may have a higher copayment or deductible and coinsurance, based on your plan. This document contains information about commonly prescribed medications. The comprehensive formulary medica healthcare plans medicaremax 3 drug list a formulary drug list is a list of covered drugs selected by your plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Uha essential health benefits formulary reference guide effective 112016 formulary design uhas formulary structure features generics, preferred and nonpreferred brandname drugs, oral chemotherapy drugs, and aca affordable care act preventive drugs. Nsaids, combinations 2016 value formulary 01012016 introduction. Your formulary this formulary outlines the most commonly prescribed medications from your plans complete pharmacy benefit coverage list, also known as a prescription drug list pdl.
Generics should be considered the first line of prescribing. This document can assist medical providers in selecting clinicallyappropriate and costeffective products for their patients. Your 2016 prescription drug list effective july 1, 2016 please read. The formulary list may not include all drugs covered by your prescription drug benefit. We realize that this formulary reference guide may not include every drug from every manufacturer. This formulary was current at the time of printing and is subject to change. By accessing the formulary online, providers will be assured that current formulary information is available for reference. Off formulary for all but quebec off formulary for quebec. Your 2016 formulary signaturevalue threetier effective july 1, 2016 please read. Below is the formulary, or drug list, for optimum platinum plan hmo from optimum healthcare, inc. This includes the bracket, scores, stats and records. For more recent information or other questions, please. Premiumvalue formulary reference guide formulary disclaimer. They can be filled by our preferred specialty pharmacy, briovarx.
The drugs listed in the kidzpartners formulary are intended to provide sufficient options to treat the majority of. June 15, 2016 important information regarding july 1, 2016 formulary changes effective july 1, 2016 health new england and minuteman health will no longer cover the following medications. A formulary identifies the drugs available for certain. October 2016 advanced control specialty formulary the cvs caremark advanced control specialty formulary is a guide within select therapeutic categories for clients, plan members and health care providers. The official 2016 college mens soccer bracket for division i. This is how much you will pay when you fill a prescription. Keystone first will follow the dhs pdl for drugs and drug classes that are included on the pdl.
The optum premium formulary is a partiallyclosed formulary. These brandname medications have been identified as having available generic equivalents covered at tier 1 on the formulary. The brandname medications below are excluded on the formulary. Tiers are the different cost levels you pay for a medication. July 1, 2016 formulary changes effective july 1, 2016 health new england and minuteman health will no longer cover the following medications. In the event we make a midyear nonmaintenance formulary change, you will be sent a formulary update notice to place in this printed formulary. Check your benefit summary about specialty drug coverage under your plan. Your prescription drug list this prescription drug list pdl outlines the most commonly prescribed medications from your plans complete pharmacy benefit coverage list, also known as a formulary. Nsaids, combinations 2016 value formulary 0101 2016 introduction. Rather, it is offered as a tool to help plan members and providers recognize formulary drugs to facilitate the appropriate drug therapy. This formulary offers a wide range of medications from which to choose.
Acanya gel edarbi fluoxetine 60mg neosynalar cream solodyn alcortin gel edarbyclor lidocaine 3% lotion proventil veltrix. The premium formulary is intended to help maintain affordable medication access and promote the use of lowercost alternatives. This document contains information about the drugs we cover in this plan this formulary was updated on 0628 2016. Watch the tournament on these networks or online at ncaa. Heres everything you need to know about the 2016 ncaa tournament. For more recent information or other questions, please contact. On march 15, the ncaa division i mens basketball committee will select eight teams to. Independence administrators prescription drug formulary. This document contains information about the drugs we cover in this plan this formulary was updated on 0526 2016. Generally, if you are taking a drug on our 2016 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2016 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released.
For more recent information or other questions, please contact silverscript customer care at 18663292088, 24 hours a day, 7 days a week. For an uptodate formulary drug list, please call us. For a complete uptodate formulary drug list, please call us. The drugs on the premium formulary have been selected for their clinical effectiveness, safety, and savings. For more recent information or other questions, please contact the bluechip for medicare concierge team, at 4012772958 or 18002670439 tty us. For more recent information or other questions, please contact us, prescription blue pdp. Below is the formulary, or drug list, for optimum diamond rewards hmo snp from optimum healthcare, inc. For more recent information or other questions, please contact todays options ppo at 18664225009 or, for tty users, 711, 8. For more recent information or other questions, please contact texanplus hmo at 186623025 or, for tty users, 711, 8. Your 2016 prescription drug list optumrx 1 effective january 1, 2016. Formulary frequently asked questions faqs at optimum.