It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of January 1, To get updated information about the drugs covered by Advantage by Buckeye Community Health Plan please visit our Web site at www.
Advantage by Buckeye Community Health Plan reviews the formulary each month. Formulary changes will be included in your monthly Part D explanation of benefits. Updated formularies are also uploaded on the plan's website month and are available in print form upon request. Please contact our Member Services department for more information. How do I use the Formulary? There are two ways to find your drug within the formulary: 1.
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Medical Condition The formulary begins on page The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Agents.
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If you know what your drug is used for, look for the category name in the list that begins on page Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index.
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Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs?
Advantage by Buckeye Community Health Plan covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage.
This means that you will need to get approval from Advantage by Buckeye Community Health Plan before you fill your prescriptions. This may be in addition to a standard one month or three month supply. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page You can ask Advantage by Buckeye Community Health Plan to make an exception to these restrictions or limits. What are over-the counter OTC drugs?
The list of OTC items and ordering instructions is available on the Advantage by Buckeye Community Health Plan website, and also available in hard copy in the new member welcome packet and Annual Notice of Change mailing. What if my drug is not on the Formulary? If your drug is not included in this list of covered drugs, you should first contact Member Services and ask if your drug is covered. This document includes only a partial list of covered drugs, so Advantage by Buckeye Community Health Plan may cover your drug.
If you learn that Advantage by Buckeye Community Health Plan does not cover your drug, you have two options: 1. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Advantage by Buckeye Community Health Plan. See below for information about how to request an exception. There are several types of exceptions that you can ask us to make. For example, for certain drugs Advantage by Buckeye Community Health Plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more.
This would lower the amount you must pay for your drug. Please note, if we grant your request to coverage a drug that is not on our formulary, you may not ask us to provider a higher level of coverage for the drug. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your prescriber's or physician supporting your request.
Generally, we must make our decision within 72 hours of getting your prescribing physician's supporting statement.
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You can request an expedited fast exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescriber's or prescribing physician's supporting statement. What do I do before I can talk to my doctor about changing my drugs or requesting an exception?
As a new or continuing member in our plan you may be taking drugs that are not on our formulary.
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Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30 -day supply unless you have a prescription written for fewer days when you go to a network pharmacy. After your first 30 day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days.
If you are a resident of a long-term care facility, we will cover a temporary 31 day transition supply unless you have a prescription written for fewer days. We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31 day emergency supply of that drug unless you have a prescription for fewer days while you pursue a formulary exception. For current enrollees whose drugs are no longer on the Advantage by Buckeye Community Health Plan formulary, Advantage by Buckeye Community Health Plan covers a temporary day supply unless you have a prescription written for fewer days when you go to a network pharmacy.
After your first 30 day supply, we will not pay for these drugs. For more information For more detailed information about your Advantage by Buckeye Community Health Plan prescription drug coverage, please review your Evidence of Coverage and other plan materials. Or, visit www.
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Sírvase revisarlo para asegurarse de que todavía contenga los medicamentos que usted recibe. Los beneficiarios deben usar farmacias de la red para acceder a su beneficio de medicamentos recetados. Un formulario es una lista de medicamentos cubiertos seleccionados por Advantage by Buckeye Community Health Plan en consulta con un equipo de proveedores de atención médica, que representa las terapias recetadas que se cree son una parte necesaria de un programa de tratamiento de calidad. Creemos que es importante que tenga acceso continuo por lo que queda del año de cobertura a los medicamentos del formulario que estaban disponibles cuando usted eligió nuestro plan, excepto por casos en los que puede ahorrar dinero adicional o nosotros podemos garantizar su seguridad.
Si la Administración de Alimentos y Medicamentos considera que un medicamento de nuestro formulario no es seguro o el fabricante del medicamento retira el medicamento del mercado, nosotros lo retiraremos inmediatamente de nuestro formulario e informaremos a los miembros que lo reciben. Para obtener información actualizada sobre los medicamentos cubiertos por Advantage by Buckeye Community Health Plan, visite nuestro sitio Web en www.
Advantage by Buckeye Community Health Plan revisa el formulario cada mes. Hay dos maneras de encontrar su medicamento dentro del formulario: 1.
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