You have access to more than 36,000 participating pharmacy locations nationwide. Information for emergency prescription fills for Washington Commercial Members. Emergency Prescription Fills (PDF) - Applies to Washington Commercial Members only.Information about which preventive drugs are covered without imposing a copayment, coinsurance or deductible. Coverage of Affordable Care Act (ACA) preventive drugs (PDF).Self-Administered Drug Exclusion List - Inclusive of All Lines of BusinessĪ summary of upcoming changes to your formulary.For Medicare Part B - Refer to Noridian Healthcare Solutions' Self-Administered Drug Exclusion Policy:.Self-Administered Drug Exclusion Policy Effective for Commercial and Medicaid members.Self-Administered Drug definition - Medications which have been identified as being medically appropriate for administration by a patient or caregiver, safely and effectively, without medical supervision.Ĭertain medications considered to be usually self-administered by the patient or their caregiver are excluded from coverage under the medical benefit without prior-authorization. Site of Care Prior Authorization Request Form (PDF).Please Note: This policy only applies if you receive medical insurance through Providence Health Plan A separate prior authorization may be required for the drug. Providence Health Plan (PHP) requires site of care prior authorization for the drugs listed below when given in an unapproved hospital outpatient setting. Infused drugs are covered under your medical benefit. Infusion Therapy Site of Care Policy – Commercial Members (Individual, Small Group and Large Group Plans) Medical Benefit Drug Prior Authorization List (PDF).For pharmacy benefit drug prior authorization information, please refer to your current formulary above. Additional exclusions may apply based on benefit and contract terms. The following list is intended to provide guidance regarding coverage of drugs that are typically administered by a healthcare professionals (such as your doctor) and is not all-inclusive. Providence Health Plan drug coverage prior authorization form (secure email)įor more information on what is a prior authorization and other limits see the Pharmacy FAQ.Uniform prior authorization prescription request form (PDF).To request authorization or an exception to any restrictions, your doctor can complete one of the following forms or you can use the secure email link and submit to the health plan. ![]() You can use the formulary information above to determine if your drug requires prior authorization or has any other restrictions. Harrison Electrical Workers Trust (Rx Only) - Effective Ortho & Fracture Specialists - Option Advantage B If you are employed by one of the following, select your formulary here: HSA Qualified Plans with Safe Harbor (6-tier) Prescription drug coverage effective on or after Jan. You may search the formulary by medical condition category and look for a medication classified as generic. ![]() A new prescription is needed to obtain a generic alternative drug. According to clinical evidence, a generic alternative can be expected to treat the same condition as well as the brand-name alternative. ![]() Generic Alternatives: A generic alternative is a generic drug that is used to treat the same condition as a brand-name drug it is not the exact same medication as the brand-name drug. There are two ways you, your representative or prescriber can initiate a prior authorization request: Complete the Providence Health Plan drug coverage prior authorization form or your provider may use the drug prior authorization form to submit the exception request. If the prescription drug is not covered, your provider may request an exception be made. If you currently take a prescription drug not on the formulary, contact customer service to make sure the drug is not covered. The online search results will provide information about the tier the drug may be on and any associated restrictions (such as prior authorization or quantity limitations).įormulary Exception: There may be times when you require a drug that is not on the formulary. Once selected, you can search your online formulary for the prescriptions you are inquiring about. Your formulary is easy to search, includes information about the drug, and includes special considerations about the prescription, if they apply.įind your pharmacy benefit formulary below by first selecting the type of health plan you have, then clicking on the link for the formulary that applies to your medical plan. Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary (list of covered drugs) designed to promote safe, effective, and affordable drug therapy.
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