Provider Guide - the Culinary Health Fund

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Provider Guide October 2012 Prescription Benefits Generic Medications Generics are safe, effective and FDA approved. The Culinary Health Fund works hard to control rising prescription costs and protect our participants’ health benefits. We urge you to help by prescribing generic medications when appropriate. Culinary Health Fund participants pay no co-pay at the Culinary Pharmacy if the generic medication is available. Effective July 1, 2012, Culinary Health Fund implemented a clinical prior authorization program for all Oral Specialty Medications. Walgreens Specialty Pharmacy will fill prescriptions for the oral specialty products, and deliver them to the plan participant preferred location. All specialty prescriptions will be limited to a 30-day supply. Mail Service Pharmacy (Catalyst Mail) The Culinary Health Fund offers a mail order prescription program through Catalyst Mail. Culinary Health Fund participants can take advantage of up to a 60-day supply of their medications for only one co-pay. A sample of the mail order form and brochure is on the website at www.culinaryhealthfund.org. To contact Catalyst Mail directly, please call 866-834-0449. E-Prescriptions The Culinary Pharmacy accepts e-prescriptions. Providers can submit prescriptions electronically to reduce the risk of medication errors due to illegible handwriting and manual data entry. Using e-prescriptions saves you and the participant’s time by reducing the number of phone calls related to faxes not being received by the pharmacy. Please use ID 2990124. Formulary Advantage Program (FAP) The FAP is a formulary management program that targets medications within 17 drug classes and encourages the selection of clinically effective, lower cost medications that support patient’s treatment adherence by lowering out-of-pocket prescription costs. Under this program, Culinary participants must try a preferred alternative before a nonpreferred brand-name medication will be covered by their prescription drug plan under the targeted drug classes (listed at right). For a complete list of preferred and non-preferred medications, please contact Catalyst Rx at 866-611-5960 or visit our website at www.culinaryhealthfund.org. Albuterol Inhalers Androgens Atypical Antipsychotics Blood Pressure Fenofibrates/ Triglycerides Growth Hormones Drug Class Interferons for HEPC Intranasal Steroids Multiple Sclerosis Ophthalmic Prostaglandins (Glaucoma) Osteoporosis Proton Pump Inhibitors Ulcers SSRIs/Antidepressants Triptans Hepatitis C Antivirals Hypnotics/Sleep Aids TNF Inhibitors (Rheumatoid Arthritis) 14 Culinary Health Fund Administrative Services, LLC
October 2012 Provider Guide Prescription Benefits Medication Prior Authorization Prior authorization is required for certain medications (see the list below). This list may be updated from time to time. Providers may call Catalyst Rx at 866-611-5960 for updates to this list, or call Provider Services at 702-892-7313. Medications Requiring Prior Authorization: • Acne Products for participants over the age of 24 • ADD/ADHD for participants over the age of 18 • Contraceptives: Authorization is required for dependent children under the age of 19. • Growth Hormone • Injectables except for insulin or Injectable Migraine Medications • New Medications to the Market • Nutritional Supplements for PKU (all other Nutritional Supplements are excluded) • Nuvigil/Provigil • Oral Specialty (Cancer, MS, etc.) • Sexual Dysfunction Medications • Singular: Participants over the age of 12 for diagnoses other than asthma • Tazorac • Thyrogen (all other Diagnostics/Biologicals are excluded) • Weight Loss Medications Narcotic Medications The medications listed in Table A will be covered only when prescribed by a PPO physician. Table A Avinza Methadone MS Contin Duragesic Methadose Opana ER Fentanyl Lozenges Morphine Sulfate CR Opana Fentanyl Transdermal Patches Morphine Sulfate ER Oramorph SR Kadian Morphine Sulfate SA The medications listed in Table B will be covered only when prescribed by a PPO oncologist or pain management specialist. Table B Oxycontin Abstral Butrans Oxycodone ER Actiq Oxecta Oxycodone CR Fentora Lazanda Oxycodone SA Marinol Nucynta ER Levorphanol Onsolis Subsys Spray Culinary Health Fund Administrative Services, LLC 15
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Page 35 and 36: CULINARY HEALTH FUND ADMINISTRATIVE
Page 37: HIGH TECH DIAGNOSTIC SERVICE REVIEW
Page 41: 1901 Las Vegas Blvd. So. Suite 101
Page 45: CULINARY PROVIDER RECONSIDERATIONS
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Provider Guide - the Culinary Health Fund

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