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- Preferred Drug List (Formulary)
- Specialty Medications
- Mail Order Pharmacy
- Questions
Preferred Drug List (Formulary)
What is a Preferred Drug List (formulary)?
A Preferred Drug List is a list of medications that are covered at the highest level by your health plan. Think of the Preferred Drug List as a medicine cabinet. You wouldn't stock your medicine chest with all available products; instead, you choose what you think would be best for different uses. At HealthPartners, we choose medications that have been demonstrated to be safe, effective and affordable. Those medications make up the Preferred Drug List.
Who decides what's in the Preferred Drug List?
Thousands of medications are available in the United States, including brand-name medications, generic equivalents and various doses and formulations. Not every medication on the market is appropriate for everyone. Nor are the heavily advertised new drugs necessarily any better than what's already available. That's why HealthPartners looks to clinical experts to determine what to include on the Preferred Drug List. Decisions on which medications to include are made by physicians and pharmacists on a Pharmacy and Therapeutics Committee. The committee develops, manages, updates and administers the Preferred Drug List.
How is the decision made to include a medication on the Preferred Drug List?
The Pharmacy and Therapeutics Committee meets regularly to review new medications on the market and medications suggested by HealthPartners physicians. These experts look at effectiveness, safety, side effects and other criteria, such as ease of use. Only after considering all those factors do they look at cost. To minimize the amount you pay for medications and healthcare, the committee tries to include the least costly option among medications that are equally effective.
Why does HealthPartners use a Preferred Drug List?
Using a Preferred Drug List is used not only to protect you from unsafe products, but also to help use your premium dollars responsibly. With pharmaceutical costs increasing and pharmaceutical companies advertising heavily to drive up consumer demand for new products, the savings achieved by using a Preferred Drug List are critical in keeping your healthcare premiums affordable while providing the best care.
What if my medication is not on the Preferred Drug List?
Doctors don't always remember to prescribe from HealthPartners Preferred Drug List. If your doctor prescribes something for you, you may want to ask if the medication is on the HealthPartners Preferred Drug List. If it isn't, you may want to ask your doctor whether a formulary item would be suitable for you. In some cases, you may need a medication that is not on the Preferred Drug List. Your doctor can request an exception for the non-formulary item to be covered by your benefits. Generally, the approval will be granted or denied on the same day as the request was made by your doctor.
Why do some medications require prior approval (PA)?
For certain medications, the Pharmacy and Therapeutics Committee has developed criteria that must be met before the medications will be approved to be covered by your benefits, even if the medication is on the Preferred Drug List. Your doctor must request coverage for these drugs on your behalf. Generally, the decision will be made the same day the request is made by your doctor. These medications are noted on the Preferred Drug List with a "PA" after their names.
What is Step Therapy?
In some situations, your doctor will need to prescribe one medication before trying another to use "Drug A" before trying "Drug B," in other words. This sequential approach is called "Step Therapy." If "Drug A" doesn't work for you, then your doctor may prescribe "Drug B," and coverage for "Drug B" will automatically be approved for you at the pharmacy. If "Drug A" has not already been prescribed for you, your doctor will need to specifically request coverage of "Drug B" on your behalf. Generally, the decision will be made the same day the request was submitted. Step Therapy medications are noted on the formulary with a "ST" after their names.
What does the $ symbol mean on the Preferred Drug List?
The "$" symbol next to the medication name in the online HealthPartners Preferred Drug List indicates the average retail price for a typical prescription of the medication, excluding any benefit coverage you may have. This amount represents the total cost. The price listed is usually for a 30-day supply.
Specialty Medications
What are specialty medications?
Specialty medications are medications for chronic illnesses and complex diseases that can be expensive and complicated to administer. A list of specialty medications is available on healthpartners.com/pharmacy.
What is SpecialtyScripts™ Pharmacy?
HealthPartners partners with SpecialtyScripts™ Pharmacy to provide members with specialty medications. With SpecialtyScripts™ Pharmacy, you receive one-on-one consultation with an experienced pharmacist who can answer questions and offer expertise about your medication(s). In addition, you will get support 24/7 and refill reminders that make receiving your specialty medications easier than ever.
What services does SpecialtyScripts™ Pharmacy provide?
SpecialtyScripts™ Pharmacy specializes in medications that are prescribed for complex conditions. Because SpecialtyScripts™ Pharmacy dispenses these medications daily, they have more experience with them than most local pharmacies or any mail order services and are better able to answer questions. They also regularly stock these medications; most local pharmacies need to special order them. SpecialtyScripts™ Pharmacy is also staffed to counsel and educate patients about using injectable medications properly. In addition to having nurses and pharmacists on staff during regular business hours, SpecialtyScriptsTM Pharmacy provides 24/7 access to a pharmacist by phone. Please contact SpecialtyScripts Pharmacy with any questions toll-free at 1-866-294-1760, Monday through Friday from 7:30 a.m. to 6 p.m., CST. Plus, in 2009 SpecialtyScriptsTM Pharmacy will be building a facility in the Twin Cities.
How do I get my specialty prescriptions?
The specialty medications will be delivered to your home, to a place of your choice or to your physician's office, depending on the type of medication.
Should I ask for anyone specific at SpecialtyScriptsTM Pharmacy?
SpecialtyScripts™ Pharmacy has a team dedicated to HealthPartners members and can be reached toll-free at 1-866-294-1760, Monday through Friday from 7:30 a.m. to 6 p.m., CST. HealthPartners Riverside Pharmacy has staff dedicated to HealthPartners members receiving growth hormone and can be reached by calling 612-371-1726.
How will the specialty medications be delivered?
As a HealthPartners member, your specialty medication(s) are delivered for free. Orders are delivered via UPS or FedEx. SpecialtyScripts™ Pharmacy will use the shipment method necessary to ensure that you have your medication(s) when you need it.
Mail Order Pharmacy
Do you have a mail order pharmacy?
Yes. Please visit healthpartners.com/mailorder or call 952-833-0497 or 1-888-356-6656 to learn more or get started.
Can I refill prescriptions online?
Yes. Use the online prescription refill service at healthpartners.com/mailorder to have prescriptions mailed directly to you with no shipping fee.
How can I get started with Mail Order?
Call Mail Order Customer Service at 952-833-0497 or 1-888-356-6656, Monday through Friday from 7 a.m. to 6 p.m. and Saturday from 8 a.m. to 4 p.m. CST. Our Customer Service Representatives will take care of transferring the prescription for you. Or, you can visit healthpartners.com/mailorder and follow step-by-step instructions.
Why should I use Mail Order?
With most HealthPartners health plans, members can get a three-month supply for two copays thats like one month free! Plus, shipping is always free!
How do I know if I have a Mail Order Pharmacy benefit?
All benefit questions should be directed to HealthPartners Member Services at 952-883-5000 or 800-883-2177.
How do I pay my copay or coinsurance?
You can pay be credit card or by check. MasterCard, Visa, Discover or American Express are the preferred payment method. Payment is required prior to shipping. Checks are accepted for the amount of the order only.
How long does it take to receive an order?
Prescriptions are usually sent within three business days. Prescriptions requiring approval from a doctor are usually sent within five business days.
Is there a shipping charge?
No, shipping is free. Prescriptions are sent through the USPS.
How can order I refill my prescription?
Visit healthpartners.com/mailorder to order a refill online. You can also call the automated refill line 24/7 at 1-800-591-0011. Or, call Mail Order Customer at 952-833-0497 or 1-888-356-6656. If no refills are available, Mail Order pharmacy will contact your doctor for authorization.
What if medications are needed before an order can arrive in the mail?
Please call Mail Order Customer Service to discuss your options at 952-833-0497 or 1-888-356-6656, Monday through Friday from 7 a.m. to 6 p.m. and Saturday from 8 a.m. to 4 p.m. CST.
What if I have questions about my medication?
Please call Mail Order Customer Service and they will transfer you to a pharmacists can answer any questions. Call 952-833-0497 or 1-888-356-6656, Monday through Friday from 7 a.m. to 6 p.m. and Saturday from 8 a.m. to 4 p.m. CST.
How do I check the status of my prescription?
You can check the status online at healthpartners.com/mailorder or call Mail Order Customer Service Department at 952-833-0497 or 1-888-356-6656.
Questions
Who do I contact with questions about my prescriptions or benefits?
For questions about specific prescriptions, please contact the doctor who prescribed the medication.
For questions about your pharmacy benefits, please call HealthPartners Member Services at 952-883-5000 or 1-800-883-2177. Available Monday through Friday from 7 a.m. to 7 p.m. If you have a hearing impairments, please call our TTY line at 952-883-5127.
For questions about ordering prescriptions for specialty medications, please call SpecialtyScriptsTM Pharmacy at 1-866-294-1760, Monday through Friday from 7:30 a.m. to 6 p.m. CST.
For questions about using HealthPartners Mail Order Pharmacy, please call 952-833-0497 or 1-888-356-6656, Monday through Friday from 7 a.m. to 6 p.m. and Saturday from 8 a.m. to 4 p.m. CST.
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