This document contains information about commonly prescribed medications. Go to for complete drug information since the formulary may change, we encourage you to visit our website, or. If the food and drug administration fda declares a drug on our drug list to be unsafe, or if the drugs manufacturer removes the drug from the market, your plan will immediately remove the drug from the drug list and notify members who take the drug. Your 2015 prescription drug list westminster village. Your prescription drug list formulary this formulary outlines the most commonly prescribed medications covered under your plans prescription drug benefits. We support specialty treatments and take a handson approach to patient care that makes a meaningful imprint on the health and quality of life of each patient. Contract have been complied with and to keep such insurance coverage and. For example, in 2015, cvs caremark said that it reduced its plan members. Generally, if you are taking a drug on the 2015 drug list that was covered at the beginning of the year. Jul 31, 2015 changes may vary by plan or formulary. Some items listed are not currently covered by iowa medicaid pdl and may not be on the final iowa medicaid pdl. Briovarx and optumrx approaches to value and affordability michael zeglinski, briovarx and optumrx pbgh waste free formulary lauren vela, pacific business group on health options for value and affordability kathy donneson, calpers reference pricing as a purchaser strategy for managing drug prices. If the request is for a drug not listed on the ahcccs drug list, the documentation must.
Due to the constantly changing nature of drug therapy, the formulary is a dynamic document and is subject to change without notice. Please contact the optumrx pharmacy help desk if you have any questions regarding processing of a transition supply for part d drugs for new members starting march 1, 2015. Arizona health care cost containment system ahcccs revised. Please refer to the websites for more change details, including current drug tier placement. We will post all changes to the 2015 prescription drug. Your 2015 prescription drug list optumrx 1 effective january 1, 2015.
However, choosing a generic or preferred drug when it is. To search for drug pricing information, you must sign in to your optumrx account. Specialty medication medication is designated as a specialty pharmacy drug. Select formulary reference guide professionals optumrx.
Once the page is opened, select the year, your county and plan. Read more with our easytouse tools, youll get the info you need to find the right drug and pricing options for you. The enclosed drug list is current as of the date printed on the cover. Observations on trends in prescription drug spending. Call the tollfree member phone number on your health plan id card. A formulary identifies the drugs available for certain conditions and organizes them. Coverage is determined by the consumers prescription drug. 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. Covered brandname drugs not on optumrx formulary plan features innetwork coverage.
In the united states, a pharmacy benefit manager pbm is a thirdparty administrator of. Connecting billions of data points, we empower doctors to make informed decisions. Premiumvalue formulary reference guide formulary disclaimer. Search for providers who cover medicare part beligible. Prescription drug list updates for medicare plan optumrx help desk at. A formulary is a list of covered drugs selected by state health plan ppo in consultation with optumrx and a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Visit or locate a participating retail pharmacy by zip code. You will be required to pay your copayment or coinsurance amount to the network pharmacy at the time your prescription is filled. Health formerly cvs caremark and united healthoptumrxcatamaran. Read more easily manage your medications, claims, and orders on any device whether at home or on the go. All other brand or product names are trademarks or registered marks of their respective owners. To search for a drug name within this pdf document, use the control and f keys on your keyboard, or go to edit in the dropdown menu and select findsearch. We support specialty treatments and take a handson approach to patient care that makes a meaningful imprint on. To access the optumrx formulary on the optumrx website, there are two options.
Select formulary reference guide consolidated health plans. Download the app to keep track of your prescriptions, compare prices and more. Due to the constantly changing nature of drug therapy, the formulary is a dynamic document and is subject to. Comprehensive formulary drug list a formulary 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. For a complete listing, please refer to the pharmacy drug list pdl on the employee wellness and benefits web site. Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals that. The purpose of this report is to provide an overview of three legislative and regulatory concerns that legislators, policymakers, customers, and pharmacies have raised regarding the pharmacy benefit management pbm industry.
Optumrx pharmacy care services pharmacy benefit management. As pbm for the feeforservice pharmacy benefit, optumrx has the following responsibilities. We tackle trends and pinpoint solutions for our clients. An exception occurred while searching for this drug. Pa prior authorization required your doctor is required to provide additional. The medication request form is also used to request overrides for step therapy, quantity limits and other edits. A formulary identifies the drugs available for certain.
This document contains information about the drugs covered under your pharmacy bene t plan. Many health plans use the formulary to help manage the overall cost of providing prescription drug benefits. Coverage for some drugs may be limited to specific dosage forms andor strengths. Visit locate a participating retail pharmacy by zip code. This happens by constructing a formulary or list of specific drugs that will be. Medications may move to a higher tier or be excluded from coverage on january 1 or july 1 of each year. Plan website help desk phone number public school employees retirement system psers 8883261196. March 1, 2016 optumrxs specialty pharmacy, briovarx, has received the. This abridged formulary drug list is not a complete list of drugs covered by our plan.
We realize that this formulary may not include every drug from every manufacturer. On the search page, type in your drug name or drug category in the search box. This document contains information about some of the drugs we cover in this plan. Optum specialty is a truly patientcentric specialty pharmacy. Optumrx is guided by the pharmacy and therapeutics committee. If the request is for a drug not listed on the ahcccs drug list, the documentation must demonstrate why the member cannot use the medications listed on the drug list. Fill the prescription at a network pharmacy products available will include nicotine replacement gum, lozenges, patches and generic zyban. The benefit design determines what is covered and the applicable copayment. Optumrx threetier prescription drug plan for endowed faculty.
This website is the best source for uptodate information about the medications your pharmacy benefi t covers, possible lowercost options, and cost comparisons. Please enter a full or partial drug name to search. Type in the word or phrase you are looking for and click on search. Call optumrx specialty pharmacy at 18887395820 and have your. Visit s locate a participating retail pharmacy by zip code. The 1st column of the pdl is for major drug categories such as antibiotics which are then broken down into subcategories such as penicillins. We realize that this formulary reference guide may not include every drug from every manufacturer. Optumrx acts as the pharmacy benefit manager for a majority of calpers health plans. Arizona health care cost containment system ahcccs. It is not intended to be a complete list of medications, and not all medications listed may be covered under your plan. Comprehensive formulary drug list a formulary 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. However, you can provide access to the medications your patients need to stay healthy, at a cost that is more affordable, when you choose a generic or preferred drug as appropriate. Optumrx is the specialty pharmacy that can provide most of your specialty medications along with helpful programs and services. An important part of the pdl is giving you choices so you and your doctor can choose the best course of treatment for you.
As a pharmacy care services company, optumrx goes beyond traditional pharmacy benefit management. This work starts with an independent, clinically based formulary design. To find the drug coverage for your health plan, you can. Covered generic drugs covered brandname drugs on optumrx formulary. This formulary offers a wide range of medications from which to choose. Attachment b redline changes to contract with optumrx administrative. Mail this completed order form with your new prescriptions to optumrx, p. Gl15425 adcetris brentuximab vedotin formulary optumrx sp. Formulary information list of covered drugs a formulary is a list of drugs covered by your plan to meet patient needs. By 2015 specialty medications accounted for onethird of all spending on drugs in the. Where differences are noted between this formulary and your benefit plan documents, the benefit plan documents will rule.
Your copayment amount for nonpreferred drugs is higher than for preferred. The drug name, available dosage, formulary status and whether the drug. The claims administrator maintains a prescription drug formulary, which is a list of outpatient prescription drugs. Optumrx threetier prescription drug plan for endowed faculty and staff. Your 2015 formulary signaturevalue effective july 1, 2015 please read. Qualchoice health insurance pharmacy and drug formulary. Briovarx, the optumrx specialty pharmacy, can provide most of your specialty medications along with helpful programs and. Please note, not all specialty medications are listed in the formulary. A formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers.
Optumrx earns pbmi excellence award for briovalive, industrys. The formulary is also known as the prescription drug list pdl. Optumrx negotiates better prices with drug manufacturers for our. Your 2015 formulary signaturevalue threetier effective january 1, 2015 please read. Prior authorization pa and related clinical call center operations preferred drug list pdl development and maintenance overthecounter otc drug formulary and.
Optumrx threetier prescription drug plan for endowed. Your 2015 formulary signaturevalue fourtier effective july 1, 2015. The first column also tells you if there is a restriction on the drug such as pre authorization pa, quantity limits ql or step therapy st. 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. We will post all changes to the 2015 prescription drug list on the following websites. Search the list of fdaapproved drugs and coverage for each by entering a drug name below. Your 2015 prescription drug list effective january 1, 2015 please read. They also make sure there are safe and covered options. Your 2015 prescription drug list insurance marketing center.
The medications listed on this formulary are subject to change pursuant to the formulary management activities of optum. If your pharmacys retail price for a drug is less than the copayment, you will not be required to pay more than that retail price. A formulary identifies the drugs available for certain conditions and. Be sure to ask your doctor if a generic drug is right for you. Call the tollfree member phone number on the back of your health plan id card. October 2015 health insurance marketplace standard drug list. Optumrx replaced cvscaremark on january 1, 2017 in administering prescription drug benefits for about 486,000 calpers members and their families. Fdaapproved generic equivalents will be dispensed for brandname drugs whenever possible, unless. Prior authorization pa and related clinical call center operations preferred drug list pdl development and maintenance overthecounter otc drug formulary and pharmacy supplements formulary maintenance. Your 2015 formulary signaturevalue fourtier effective july 1, 2015 please read.
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