If your benefit plan includes pharmacy services through PHP you have access to a nationwide network of pharmacies for prescription refills. PHP maintains Prescription Drug Lists (PDL) and has prior authorization procedures in place, which will allow a member access to non-PDL products when medically necessary. The PDL includes representation from each therapeutic class. **Please note - this information is for members who have a commercial policy with PHP and does not apply to those with Medicaid or PHP FamilyCare.** If you require specialty medications (such as those given in a physician's office or self-injectibles) please utilize the Accredo Health Specialty Pharmacy or the CVS Caremark Specialty Pharmacy Services.
You have choices. Understanding them will help you make informed health care decisions.
Your prescription benefit provides you with many choices. This information is meant to help you understand those choices. It will also enable you to ask you doctor or pharmacist the right questions regarding your medication needs. Our goal is to provide information that will help you make informed decisions regarding medications for you and your family.
The prescription benefit is designed to provide you with a comprehensive selection of prescription drugs. Together with your doctor, you may refer to the lists below to consider your choices and select the appropriate medication to meet your needs. Keep in mind that your Certificate of Coverage defines your actual benefit coverage and may exclude coverage for certain drugs listed in the PDLs.
We offer two seperate prescription drug list formularies that are chosen by your employer for your benefit plan. To verify the drug coverage you have you can contact PHP's customer service at 1.800.832.9186 or online at www.express-scripts.com. Pharmacy benefits are provided by Express Scripts Incorporated formerly known as Medco Health Incorporated.
Note: Coverage is determined by the member's prescription drug benefit.
These lists are subject to change.
Through Express Scripts (formerly known as Medco) Mail Order, you can get a 90-day supply of certain maintenance medication for only $10! $10 Maintence Medication Flyer
Our providers are educated to prescribe any drug that is deemed medically appropriate for the patient from the PDL. To obtain access to non-PDL medications, providers can request prior authorization in writing. Members can initiate the prior authorization request via email or phone but pertinent medical information required to process the request must be obtained by PHP from your Physicians office.The prior authorization criteria were developed with input from physicians as well as from current medical literature. Providers may call Customer Service at 1.800.832.9186 or 517.364.8500 and ask to be faxed a prior authorization request form. The provider should complete the form and fax it back to our on-site Pharmacy department at 517.364.8413. The provider will be notified of the decision to approve or deny the request. If a request is denied, alternatives will be suggested.
Medications listed on the PDL are covered drug products, selected according to safety and quality standards first, then by cost effectiveness. The PDL contains more than 800 drugs, representing multiple therapeutic needs. The PDL often requires the use of generic drugs.