Page 66 - EPO_Member_Kit

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P R E S C R I P T I O N S
Need a prescription? We are affiliated with most major
drugstore chains throughout our service area, ensuring
that you’ll be able to obtain those needed prescriptions
conveniently and quickly. Please make sure you take
medication(s) as instructed.
We are committed to providing high-quality and
cost-effective health care. This is the reason behind our
“generic first” approach. If you have a Dispense as
Written (DAW) prescription requiring a brand-name
medication, you will have higher out-of-pocket
expenses. For DAW prescriptions you will be
responsible for the
generic copay plus the difference
between the cost of the generic equivalent and the
brand-name
. Exceptions are based solely on medical
necessity, must be submitted by your doctor and are
determined on a case-by-case basis.
Covered Medication
In order to take advantage of the pharmacy options,
you need to have a Prescription Drug Rider through us.
Most medications approved by the Food and Drug
Administration (FDA) are covered by us. Certain
medications are not covered or have quantity
limitations.
Maintenance Medication
If your doctor prescribes medication for an ongoing
condition or to maintain your health or quality of life,
the medication may be classified as a maintenance
medication. Up to a 90-day supply is covered for
medications listed on the Alliance Maintenance Drug
List if filled at an eligible 90-day Alliance Retail
Network Pharmacy or by using the Pharmacy
Advantage Home Delivery Service. Most major
pharmacy chains and many independent pharmacies
are in the 90-day Alliance Retail Network.
Typically the charge for a 90-day supply is only two
copays but will vary for some groups or if you have an
HSA plan. Please check your Group Health Insurance
Policy. If your employer has the 30-day Prescription
Rider, you may obtain a 90-day supply of a medication
through mail order for two copays (if the drug is
eligible for a 90-day fill). The 90-Day Alliance Retail
Network allows members to obtain a 90-day supply of
a Alliance Maintenance Drug for two copays at a local
90-Day Retail Pharmacy or through mail order.
Doctors must write prescriptions for a 90-day supply in
order to fill a 90-day prescription for a medication
listed on the Maintenance Drug List. You can check the
medication name through our Drug Search at
hap.org
to see if it is on the Maintenance Drug List.
Medications That Require Prior
Authorization
Some medications require a prior authorization. If you
need to obtain medication that is not on our Formulary
or a medication that requires prior authorization,
talk to your doctor for information about medical
exceptions. We have a process for medical exceptions
that requires your doctor to apply in advance for prior
authorization and these medications are dispensed in
limited quantities.
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