They can be filled by our preferred specialty pharmacy, briovarx. To create the list, optumrx is guided by the pharmacy and. Your prescription drug list this prescription drug list pdl outlines the most commonly prescribed medications from your plans complete pharmacy benefit coverage list, also known as a formulary. This document contains information about commonly prescribed medications.
Visit or locate a participating retail pharmacy by zip code. Your pharmacy benefit offers flexibility and choice in determining the right medication for you. Premium formulary drug list cefaclor nallpendextrose cephalexin penicillin g potassium in isoosmotic the optum drug list is a guide identifying generic, preferred brand name, and nonpreferred brand name medicines within select therapeutic categories. This guide tells you if a medication is generic or. In addition, your medications will be shipped to you at no extra cost. This formulary is a list of prescription medications that are covered under optimum healthcare, inc. This document contains information about the drugs covered under your pharmacy benefit plan. Lidoderm lidocaine patch prior authorization request form. Frequently asked questions about transitioning to optumrx. A formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers.
Please fill out all applicable sections on both pages completely and legibly. You may be eligible for the convenience of home delivery, avoiding trips to. The information in this document is for the sole use of optumrx. An important part of the pdl is giving you choices so you and your doctor can choose the best course of treatment for you. The theft occurred on march 16, 2016 in indianapolis, indiana. Visit locate a participating retail pharmacy by zip code. Your 2016 formulary signaturevalue threetier effective july 1, 2016 please read. Optumrx replaced cvscaremark on january 1, 2017 in administering prescription drug benefits for about 486,000 calpers members and their families. In making the transition from the prior pbm, patient safety and evidencebased formulary management practices are incorporated using historical data. We anticipate no change to your benefit coverage as a result of the move to optumrx. The brandname medications below are excluded on the formulary. Call briovarx at 18554briova 18554274682 and have your prescriptions delivered. We are an optumtm company a leading provider of integrated health services. Select formulary reference guide consolidated health plans.
However, you can provide access to the medications your patients need to stay healthy, at a cost that is more affordable, when you choose a generic or preferred drug as appropriate. You may be eligible for the convenience of home delivery, avoiding trips to the pharmacy to pick up your medications. These brandname medications have been identified as having available generic equivalents covered at tier 1 on the formulary. The medications listed on this formulary are subject to change pursuant to the formulary management activities of optum. Optumrx acts as the calpers pharmacy benefit manager for a majority of calpers its health plans. It includes both brand and generic prescription medications.
Your 2020 formulary for the most current list of covered medications or if you have questions. Call the tollfree member phone number on your health plan id card. Find out which drugs are covered on our value 5tier plan. Check your benefit summary about specialty drug coverage under your plan. We realize that this formulary may not include every drug from every manufacturer. It includes both brand and generic prescription medications approved by the. Optumrx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Briovarx, the optumrx specialty pharmacy, can provide most of your specialty medications along with helpful programs and services. Optum essential health benefits comprehensive formulary. Premiumvalue formulary reference guide formulary disclaimer. For an uptodate formulary drug list, please call us.
To help you get the most out of your pharmacy benefit, weve included some of the most commonly asked questions about the formulary. Cease and desist notice for noncompliance of optumrx online fraud, waste and abuse cms attestation requirements opens in a new window 2016 0209. Simultaneous to the award and implementation of the new contract, the current incumbent cvs caremark has been working with calpers and the new pbm to effectively transition affected members. However, due to formulary changes, some medications may be in different tiers, which could impact your cost share. Visit your plans website on your member id card to. Basic formulary preferred drug list 2017 page 2 specialty drugs these drugs may have a higher copayment or deductible and coinsurance, based on your plan. This comprehensive formulary is a complete list of the drugs covered by our plan. The enclosed formulary is current as of january 1, 2017. Speak with your pharmacist to have your excluded brandname medication substituted with its generic equivalent. Take the guesswork out of managing your prescriptions.
Basic formulary 2017 preferred drug list effective 01012017. For those eligible for a home delivery refill in the next seven days for hasslefree fill customers who expect an order to ship within seven days. Your 2016 prescription drug list effective july 1, 2016 please read. Please note, not all specialty medications are listed in the formulary. Formulary a formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers. Look up possible lowercost medication alternatives. Your formulary this formulary outlines the most commonly prescribed medications from your plans complete pharmacy benefit coverage list, also known as a prescription drug list pdl. At optumrx, we want to help you better understand your medication options. This abridged formulary was updated on 1107 2016 and is not a complete list of drugs covered by our plan. Optumrx will be the pharmacy care services manager for your calpers prescription drug plan. On march 22, 2016, we were notified that an unencrypted laptop computer belonging to a vendor of optumrx, which provides home delivery prescription services to you, was stolen from one of its employees vehicles. Proper consent to disclose phi between these parties has been obtained. You may also ask us for a coverage determination by calling the member services number on the back of your id card. With our easytouse tools, youll get the info you need to find the right drug and pricing options for you.
Below is the formulary, or drug list, for optimum platinum plan hmo from optimum healthcare, inc. If you received this document by mistake, please know that sharing, copying, distributing or using information in this document is against the law. Table of contents click on any section or page below to go directly to that portion of the document. The benefit design determines what is covered and the applicable copayment. You and your doctor can use the formulary to help you choose the most cost effective prescription medications. Our contact information, along with the date we last updated the formulary, is on the cover. Unitedhealthcare community plan and optumrx to manage pharmacy benefits for iowa health link members effective march 1, 2016 opens in a new window. Prescription drug guide humana abbreviated formulary partial list of covered drugs humana walmart rx plan pdp region 14 state of ohio please read. Coverage for some drugs may be limited to specific dosage forms andor strengths. Remove all ranitidine products zantac if you have a prescription for ranitidine drug zantac, stop taking it and contact your prescriber for an alternative.
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