2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
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The following abbreviations may be found within the body of this <strong>document</strong>:<br />
COVERAGE NOTES ABBREVIATIONS<br />
ABBREVIATION DESCRIPTION EXPLANATION<br />
Utilization Management Restrictions<br />
PA<br />
QL<br />
ST<br />
Prior Authorization<br />
Restriction<br />
Quantity Limit Restriction<br />
Step Therapy Restriction<br />
Other Special Requirements <strong>for</strong> Coverage<br />
HI<br />
Home Infusion Drug<br />
You (or your physician) are required to get<br />
prior authorization from <strong>Alliance</strong> CompleteCare<br />
be<strong>for</strong>e you fill your prescription <strong>for</strong> this drug.<br />
Without prior approval, <strong>Alliance</strong> CompleteCare<br />
may not cover this drug.<br />
<strong>Alliance</strong> CompleteCare limits the amount of<br />
this drug that is covered per prescription, or<br />
within a specific time frame.<br />
Be<strong>for</strong>e <strong>Alliance</strong> CompleteCare will provide<br />
coverage <strong>for</strong> this drug, you must first try<br />
another drug(s) to treat your medical condition.<br />
This drug may only be covered if the other<br />
drug(s) does not work <strong>for</strong> you.<br />
This prescription drug may be covered under<br />
our medical benefit. For more in<strong>for</strong>mation, call<br />
the Care Advisor Unit at 1-877-585-7526, 8:00<br />
a.m. to 8:00 p.m., seven days a week.<br />
(TTY/TDD users should call 1-800-735-2929.)<br />
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