Page 20 - PA_PPO_Member_Kit

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Specialty Drugs:
These are prescription or medical drugs that require close monitoring for safety and
efficacy. For this reason HAP has contracted with Pharmacy Advantage, a specialty pharmacy from
which you can obtain specialty drugs. Specialty drugs require prior authorization, and Pharmacy
Advantage can help you and your doctor submit a request for prior authorization. You or your doctor
can contact Pharmacy Advantage at
(800) 456-2112
Covered Medication Facts:
a. You need a HAP or Alliance Health and Life Insurance Company (Alliance) Prescription
Medication Rider to receive our pharmacy benefits.
b. Copays and coinsurances for prescriptions are listed in your Subscriber Contract and on your ID card.
c. Coinsurance for your medical drugs is listed in your Subscriber Contract.
Maintenance Drugs
HAP offers select generic drugs that are designated as “maintenance” because they are
commonly used in our membership for managing chronic diseases. Our members can get these
maintenance drugs at most retail pharmacies for a 90-day supply. You can visit our website at
to see if your drug is listed on the HAP
Maintenance drug list.
1. You can also get a 90-day supply of most oral medications from our mail order pharmacy, Pharmacy
Advantage. The charge for a 90-day supply is normally two copays but may vary for some groups
2. Your doctor would need to write your maintenance prescriptions for a 90-day supply
The following are not covered by HAP:
1. Over-the-counter (OTC) medications, unless specified on the HAP formulary
2. Dietary food or food supplements
3. Drug products used for cosmetic purposes
4. Experimental drugs and/or any drug products used in an experimental manner
5. Replacement of lost or stolen medication
6. The cost of prescriptions filled at non-plan pharmacies
HAP Affiliated Pharmacy Network:
Most major drugstore chains in southeast Michigan are in our pharmacy network. This means that you
can get your prescriptions easily and quickly. You can visit
and select Find a Pharmacy under
the Prescriptions tab to find a retail pharmacy near you. In addition, we are affiliated with Pharmacy
Advantage Home Delivery Service so that you can refill or renew your prescriptions for a 90-day supply
safely and securely online. Prescriptions are delivered in seven to 10 working days by first-class mail.
Allow enough time for mailing so that you won’t run out of your medicine. For more details, visit or call
(800) 456-2112