2013 Formulary (List of Covered Drugs) - Advantage Peach State ...

What is the Peach State Formulary?A formulary is a list of covered drugs selected byAdvantage by Peach State Health Plan (HMOSNP) (Peach State) in consultation with a team ofhealth care providers, which represents theprescription therapies believed to be a necessarypart of a quality treatment program. Peach Statewill generally cover the drugs listed in ourformulary as long as the drug is medicallynecessary, the prescription is filled at a PeachState network pharmacy, and other plan rules arefollowed. For more information on how to fillyour prescriptions, please review your Evidence ofCoverage.Can the Formulary change?Generally, if you are taking a drug on our 2013formulary that was covered at the beginning of theyear, we will not discontinue or reduce coverageof the drug during the 2013 coverage year exceptwhen a new, less expensive generic drug becomesavailable or when new adverse information aboutthe safety or effectiveness of a drug is released.Other types of formulary changes, such asremoving a drug from our formulary, will notaffect members who are currently taking the drug.It will remain available at the same cost-sharingfor those members taking it for the remainder ofthe coverage year. We feel it is important that youhave continued access for the remainder of thecoverage year to the formulary drugs that wereavailable when you chose our plan, except forcases in which you can save additional money orwe can ensure your safety.If we remove drugs from our formulary, add priorauthorization, quantity limits and/or step therapyrestrictions on a drug or move a drug to a highercost-sharing tier, we must notify affected membersof the change at least 60 days before the changebecomes effective, or at the time the memberrequests a refill of the drug, at which time themember will receive a 60 day supply of the drug.If the Food and Drug Administration deems a drugon our formulary to be unsafe or the drug’smanufacturer removes the drug from the market,we will immediately remove the drug from ourformulary and provide notice to members whotake the drug. The enclosed formulary is currentas of November 1, 2013. To get updatedinformation about the drugs covered by PeachState please visit our website athttp://advantage.pshpgeorgia.com or call MemberServices at 1-877-725-7748, 8:00 AM to 8:00 PM,7 days a week. TTY/TDD users should call1-800-255-0056.Peach State will communicate mid-year nonmaintenanceformulary changes to members onthe monthly Part D Explanation of Benefits.Instructions for filing appeals or complaintsrelated to the formulary change will be included inthe Explanation of Benefits.How do I use the Formulary?There are two ways to find your drug within theformulary:Medical ConditionThe formulary begins on page 1. The drugs in thisformulary are grouped into categories dependingon the type of medical conditions that they areused to treat. For example, drugs used to treat aheart condition are listed under the category,Cardiovascular Agents. If you know what yourdrug is used for, look for the category name in thelist that begins on page 1. Then look under thecategory name for your drug.Alphabetical ListingIf you are not sure what category to look under,you should look for your drug in the Index thatbegins on page 144. The Index provides analphabetical list of all of the drugs included in thisdocument. Both brand name drugs and genericdrugs are listed in the Index. Look in the Indexand find your drug. Next to your drug, you willsee the page number where you can find coverageinformation. Turn to the page listed in the Indexand find the name of your drug in the first columnof the list.i