|
|
 2008 Preferred Drug Formulary
2007 Non-preferred Drug Formulary
What is a Formulary?
We have a formulary that lists all drugs that we cover. For 2008, we have included ALL covered Medicare Part D drugs in our formulary. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary; the prescription is filled through our preferred UPREHS Depot Drug Pharmacies or at a nonpreferred network retail pharmacy (30-day supply only), it is a covered Medicare Part D drug, and other coverage rules are followed. For certain prescription drugs, we have additional requirements for coverage or limits on certain drugs. These requirements and limits are described in Section 4.
The drugs on the formulary are selected by our Plan with the help of a team of health care providers. We select the prescription therapies believed to be a necessary part of a quality treatment program and both brand name drugs and generic drugs are included on the formulary. A generic drug has the same active ingredient formula as the brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand name drugs.
Not all drugs are included on our formulary. We have included all Medicare Part D covered drugs. In some cases, the law prohibits coverage of certain types of drugs. See Drug Exclusions, later in this section, for more information about the types of drugs that cannot be covered under a Medicare Prescription Drug Plan.
In certain situations, prescriptions filled at an out of network pharmacy may also be covered. See Section 1 for more information about filling prescription at out of network pharmacies.
The UPREHS Prime Medicare Plan includes some prescription drugs on our formulary that are not a Medicare Part D benefit. Our Formulary Book identifies those drugs for you. Those drugs must be obtained through the UPREHS Depot Drug Mail Order Pharmacy. If you need your prescription filled urgently, you may have a one-time-only fill at a nonpreferred network retail pharmacy. Any additional refills must go through the UPREHS Depot Drug Mail Order Pharmacy with the exception of certain specialty drugs obtained through the Ascend Specialty Drug Pharmacy. Ask your physician to write 2 prescriptions for you: a one-month supply to be filled at a nonpreferred network retail pharmacy and a long-term prescription to send to the UPREHS Depot Drug Mail Order Pharmacy.
We offer some prescription drugs not covered by Medicare Part D. The copayment you pay when you fill a prescription for these drugs does not count towards the deductible that UPREHS pays for you, the Medicare portion of your initial coverage limit, or your total out of pocket costs (that is, the amount you pay does not help you with your $4,050 out of pocket costs or to qualify for catastrophic coverage). The portion of drug costs we pay for these drugs is applied to the extra benefit that we give you to enhance your initial coverage limit. Once that amount is used by you for either Medicare Part D covered drugs, or the additional drugs we offer to you, 100% of the cost for those drugs will be paid out of pocket by you.
HOW TO USE THE UPREHS PRIME MEDICARE PLAN FORMULARY BOOK
The formulary provides coverage information about the drugs covered by UPREHS. If you have trouble finding your drug in the Therapeutic List, turn to the Alphabetical List. Generic drugs are listed in lower-case italics (e.g., amitriptyline) within the formulary lists. Brand name drugs are capitalized in the formulary lists (e.g., LEVAQUIN). There are two ways to find your drug within the formulary:
ALPHABETICAL DRUG LIST (ALPHABETICAL DRUG INDEX)
If you are not sure what Therapeutic category to look under, you should look for your drug in the Alphabetical Drug List. This is an alphabetical index providing a list of all of the drugs included in the Formulary. Both brand-name drugs and generic drugs are listed in the Alphabetical Drug List. Look in this list and find your drug alphabetically.
THERAPEUTIC DRUG LIST (MEDICAL CONDITION)
The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. This list is most often used by physicians to identify your formulary drugs. For example, drugs used to treat pain are listed under the category, Analgesics. Another example are drugs used to treat a heart condition are listed under the category, Cardiovascular Agents. If you know what your drug is used for, look for the therapeutic drug category. Then look under the Drug Name for your drug.
| Last Updated: 04/16/2008 |
 |
|
UPREHS. Plan for Life.™ 
