Presbyterian | Your Story | Centennial Care | Summer 2020

6 Presbyterian Health Plan (PHP) Centennial Care covers drugs listed on the Formulary (drug list). ● A Formulary is a list of approved drugs that PHP Centennial Care will cover. A Formulary is also called a Preferred Drug List. ● The Formulary includes notes and explains limits to your coverage. ● Please call the PHP’s Pharmacy Service Team if you would like to learn more about the drugs on the Formulary. Your providers and pharmacy (drugstore) also have a copy of our Formulary. You can find the Formulary on our website at www.phs.org . Search for “Pharmacy Resources.” ● Most of the drugs on the PHP Centennial Care drug list are generic. This means they are made the same way as brand- name drugs and have the same effect. Most generic drugs cost less. PHP has a team that reviews the drugs on the Formulary to make sure they are safe and effective. Both pharmacists and doctors are on this team. They also decide if drugs should be added or removed from the Formulary. We want you to have the right prescription drugs to improve your health, even if these prescription drugs are not on our drug list. You may need a drug that is not on the drug list. Or you may need a drug that is not approved to treat your health condition. In these cases, you or your provider can call PHP’s Pharmacy Service Team to request an exception. Or your provider can send a request to PHP Centennial Care for an exception. We will look at your request and give authorization (approval) if we decide that the non- Formulary drug is medically necessary (needed) . We usually give approval for two reasons: ● Your provider finds that a similar drug(s) on our list is not as effective in improving your health. ● Your provider finds that a similar drug(s) on our list could be harmful to your health. Getting your prescription filled To avoid problems filling your prescriptions, always ask your provider to check our Formulary. ● If your provider prescribes a drug that is not on our drug list, your provider must have approval from PHP Centennial Care before you can get that medicine. This is called a prior authorization (approval). ● Some drugs may not be covered. PHP Centennial Care will help you and your doctor find a drug that works for you or find a less expensive generic drug instead of using a brand-name drug. ● Without PHP Centennial Care approval, the pharmacy will not be able to fill your prescription under your PHP Centennial Care pharmacy benefit. When your primary care provider (PCP) or other provider gives you a prescription for medicine (drugs), you will need to get that medicine at one of the pharmacies (drugstores) listed in the PHP Centennial Care Provider Directory . These are the only pharmacies where you can get your covered medicines. Call customer service to get help finding a network pharmacy. ● A member is allowed one out-of- network fill per medication per calendar year. ● Please remember that lost, stolen, destroyed, and/or misplaced drugs are not a covered benefit. Show your PHP Centennial Care member ID card when you go to the pharmacy. If you have a problem getting your prescription filled, call PHP’s Pharmacy Service Team for help. If after hours, your pharmacy may call Presbyterian’s after-hours pharmacy help desk, if needed. You can also use our mail-order program. This program will give you up to a 90-day supply of medication delivered to your home. PHP partners with OptumRx to provide prescription mail- order/home delivery services. Check your benefit plan materials for details. To set up a mail-order account, please call their Customer Service Center at 1-866-528-5829 Your prescription drug Here are some important things to know about your drug coverage: