Prescription Drug Guide Comprehensive list of covered drugs

More documents

Recommendations

Info

Simply Healthcare Plans, Inc.2013 Formulary(List of Covered Drugs)PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WECOVER IN THIS PLANNote to existing members: This formulary has changed since last year. Please review this document tomake sure that it still contains the drugs you take.Beneficiaries must use network pharmacies to access their prescription drug benefit. Benefits,formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1,2014.Simply HealthCare Plans, Inc. is a Coordinated Care plan with a Medicare contract and a contract withthe Florida Medicaid program.This information is available for free in other languages. Please contact our Member Services number at1-877-577-0115 for additional information. If you use a TTY device, please call 711. We are open 7days a week, 8 a.m. to 8 p.m. From February 15 th until September 30 th , you may leave us a voice mailmessage after hours, Saturdays, Sundays and holidays, and we will return your call the next businessday.Esta información está disponible de forma gratuita en otros idiomas. Póngase en contacto con nuestronúmero de atención al afiliado al 1-877-577-0115 para obtener información adicional. Si usted usa undispositivo TTY, por favor llame al 711. El horario de atención es de 8 a.m. a 8 p.m., los siete días de lasemana. A partir del 15 de febrero hasta el 30 de septiembre usted puede dejarnos un mensaje en elcorreo de voz después del horario de trabajo, los sábados, domingos y días festivos y nosotros ledevolveremos la llamada el siguiente día hábil.Formulary ID: 13569 Ver. 10H5471_SHP 2013CForm_BILi
What is the Simply Healthcare Plans, Inc.’s Formulary?A formulary is a list of covered drugs selected by Simply Healthcare Plans, Inc. in consultation with ateam of health care providers, which represents the prescription therapies believed to be a necessary partof a quality treatment program. Simply Healthcare Plans, Inc. will generally cover the drugs listed inour formulary as long as the drug is medically necessary, the prescription is filled at a Simply HealthcarePlans, Inc. network pharmacy, and other plan rules are followed. For more information on how to fillyour prescriptions, please review your Evidence of Coverage.Can the Formulary change?Generally, if you are taking a drug on our 2013 formulary that was covered at the beginning of the year,we will not discontinue or reduce coverage of the drug during the 2013 coverage year except when anew, less expensive generic drug becomes available or when new adverse information about the safetyor effectiveness of a drug is released. Other types of formulary changes, such as removing a drug fromour formulary, will not affect members who are currently taking the drug. It will remain available at thesame cost-sharing for those members taking it for the remainder of the coverage year. We feel it isimportant that you have continued access for the remainder of the coverage year to the formulary drugsthat were available when you chose our plan, except for cases in which you can save additional moneyor we can ensure your safety.If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapyrestrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members ofthe change at least 60 days before the change becomes effective, or at the time the member requests arefill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food andDrug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removesthe drug from the market, we will immediately remove the drug from our formulary and provide noticeto members who take the drug. The enclosed formulary is current as of September 1, 2012. To getupdated information about the drugs covered by Simply Healthcare Plans, Inc., please visit our Web siteat www.mysimplymedicare.com or call Member Services at 1-877-577-0115. We are open 7 days aweek, 8 a.m to 8 p.m. From February 15 until the following Annual Election Period (AEP), you mayleave us a voice mail message after-hours, Saturdays, Sundays and holidays and we will return your callthe next business day. TTY/TDD users should call 711. In the event of a mid-year non-maintenanceformulary change such as changing a preferred or non-preferred formulary drug, adding an additionalrequirement or limit to a drug, remove a dosage form, or exchanging therapeutic alternatives by addingor deleting a drug or changing a tier as a result of a therapeutic alternative, we will notify you byproviding you with a written notice of the non-maintenance formulary change.How do I use the Formulary?There are two ways to find your drug within the formulary:Medical ConditionThe formulary begins on page 1. The drugs in this formulary are grouped into categories dependingon the type of medical conditions that they are used to treat. For example, drugs used to treat a heartcondition are listed under the category, “Cardiovascular Agents”. If you know what your drug isused for, look for the category name in the list that begins on page number 1. Then look under theii
Page 1: Prescription Drug GuideGuía de Med
Page 5 and 6: have two options:You can ask Member
Page 7 and 8: The information in the Requirements
Page 9 and 10: Simply Healthcare Plans, Inc.Formul
Page 11 and 12: ¿Cómo uso el formulario?Hay dos m
Page 13 and 14: estricciones de uso adicional no so
Page 15 and 16: Cobertura para obtener más informa
Page 17 and 18: Drug NameDrugTier Requirements/Limi
Page 53 and 54:
Drug NameDrugTier Requirements/Limi
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
IndexAabacavir ....................
Page 123 and 124:
chloroquine phosphate..............
Page 125 and 126:
faslodex ..........................
Page 127 and 128:
linzess............................
Page 129 and 130:
peganone...........................
Page 131 and 132:
testosterone cypionate ............
show all

Prescription Drug Guide Comprehensive list of covered drugs

Create successful ePaper yourself

Delete template?

Save as template?