This formulary is a list of prescription medications that are covered under optimum healthcare, inc. Optumrx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Call the tollfree member phone number on your health plan id card. Prescription drug guide humana abbreviated formulary partial list of covered drugs humana walmart rx plan pdp region 14 state of ohio please read. The benefit design determines what is covered and the applicable copayment. Visit your plans website on your member id card to. This guide tells you if a medication is generic or. The enclosed formulary is current as of january 1, 2017. Below is the formulary, or drug list, for optimum platinum plan hmo from optimum healthcare, inc. To create the list, optumrx is guided by the pharmacy and. If you received this document by mistake, please know that sharing, copying, distributing or using information in this document is against the law. Find out which drugs are covered on our value 5tier plan. This document contains information about commonly prescribed medications.
The theft occurred on march 16, 2016 in indianapolis, indiana. Premiumvalue formulary reference guide formulary disclaimer. For an uptodate formulary drug list, please call us. Optumrx will be the new mail service pharmacy and the optumrx call center will support mail service pharmacy inquiries a new experience within the pharmacy section of the health plans member portal. Remove all ranitidine products zantac if you have a prescription for ranitidine drug zantac, stop taking it and contact your prescriber for an alternative.
On march 22, 2016, we were notified that an unencrypted laptop computer belonging to a vendor of optumrx, which provides home delivery prescription services to you, was stolen from one of its employees vehicles. Speak with your pharmacist to have your excluded brandname medication substituted with its generic equivalent. Lidoderm lidocaine patch prior authorization request form. Our contact information, along with the date we last updated the formulary, is on the cover. Unitedhealthcare community plan and optumrx to manage pharmacy benefits for iowa health link members effective march 1, 2016 opens in a new window. 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.
In addition, your medications will be shipped to you at no extra cost. A formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers. You may be eligible for the convenience of home delivery, avoiding trips to the pharmacy to pick up your medications. Optumrx will be the pharmacy care services manager for your calpers prescription drug plan. You and your doctor can use the formulary to help you choose the most cost effective prescription medications. At optumrx, we want to help you better understand your medication options. You may be eligible for the convenience of home delivery, avoiding trips to. It includes both brand and generic prescription medications. Your 2016 formulary signaturevalue threetier effective july 1, 2016 please read.
Check your benefit summary about specialty drug coverage under your plan. Your 2020 formulary for the most current list of covered medications or if you have questions. The brandname medications below are excluded on the formulary. 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. Coverage for some drugs may be limited to specific dosage forms andor strengths.
For those eligible for a home delivery refill in the next seven days for hasslefree fill customers who expect an order to ship within seven days. They can be filled by our preferred specialty pharmacy, briovarx. Your pharmacy benefit offers flexibility and choice in determining the right medication for you. This comprehensive formulary is a complete list of the drugs covered by our plan. Look up possible lowercost medication alternatives. It includes both brand and generic prescription medications approved by the. Proper consent to disclose phi between these parties has been obtained. Please note, not all specialty medications are listed in the formulary. 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. Simultaneous to the award and implementation of the new contract, the current incumbent cvs caremark has been working with calpers and the new pbm to effectively transition affected members. We realize that this formulary may not include every drug from every manufacturer. 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. Call briovarx at 18554briova 18554274682 and have your prescriptions delivered.
Visit locate a participating retail pharmacy by zip code. In making the transition from the prior pbm, patient safety and evidencebased formulary management practices are incorporated using historical data. An important part of the pdl is giving you choices so you and your doctor can choose the best course of treatment for you. We anticipate no change to your benefit coverage as a result of the move to optumrx. Please fill out all applicable sections on both pages completely and legibly. Formulary a formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers. Cease and desist notice for noncompliance of optumrx online fraud, waste and abuse cms attestation requirements opens in a new window 2016 0209.
Briovarx, the optumrx specialty pharmacy, can provide most of your specialty medications along with helpful programs and services. We are an optumtm company a leading provider of integrated health services. Optumrx replaced cvscaremark on january 1, 2017 in administering prescription drug benefits for about 486,000 calpers members and their families. Visit or locate a participating retail pharmacy by zip code. Frequently asked questions about transitioning to optumrx.
However, due to formulary changes, some medications may be in different tiers, which could impact your cost share. Basic formulary 2017 preferred drug list effective 01012017. These brandname medications have been identified as having available generic equivalents covered at tier 1 on the formulary. This document contains information about the drugs covered under your pharmacy benefit plan. Optum essential health benefits comprehensive formulary. The drug list may not include all drugs covered by your prescription drug benefit. Premium formulary drug list cefaclor nallpendextrose cephalexin penicillin g potassium in isoosmotic the optum drug list is a guide identifying generic, preferred brand name, and nonpreferred brand name medicines within select therapeutic categories. Optumrx acts as the calpers pharmacy benefit manager for a majority of calpers its health plans. This abridged formulary was updated on 1107 2016 and is not a complete list of drugs covered by our plan. The information in this document is for the sole use of optumrx. Take the guesswork out of managing your prescriptions. Your 2016 prescription drug list effective july 1, 2016 please read.
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