Pharmacy

	Pharmacy Services

To verify drug coverage for PHP members call 877.205.2300. PHP providers may view a copy of the Prescription Drug List (PDL) by choosing one of the links below: Commercial Provider PDL Essential Commercial Provider PDL Medicaid-FamilyCare Provider PDL Medicaid-FamilyCare Over-the-Counter PDL For specialty medications please utilize the following forms Accredo-Medco Special Care Pharmacy Prescription Referral Form Synagis Form CVS Caremark Specialty Pharmacy Services Several medications for PHP FamilyCare/Medicaid members must be billed directly to the member's green MIHealth card. These medications are called carve-out medications. See the list below. For questions or authorizations regarding these drugs, please contact Magellan Medicaid Administration at 877.864.9014. Carve Out Medications as of 04/01/2013 Carve Out Medication Drug Categories as of 04/01/2013 Fill our the Medical Exception for Medication form Pharmacy PA Form and fax back to our localized Pharmacy Department at 517.364.8413. The Pharmacy PA Form is in Adobe Acrobat format and may be printed to be filled out by hand then faxed back to us. Be sure to include the Physician's signature before faxing. To verify drug coverage for PHP members call 877.205.2300. PHP providers may view a copy of the Prescription Drug List (PDL) by choosing one of the links below: Commercial Provider PDL Essential Commercial Provider PDL Medicaid-FamilyCare Provider PDL Medicaid-FamilyCare Over-the-Counter PDL For specialty medications please utilize the following forms Accredo-Medco Special Care Pharmacy Prescription Referral Form Synagis Form CVS Caremark Specialty Pharmacy Services Several medications for PHP FamilyCare/Medicaid members must be billed directly to the member's green MIHealth card. These medications are called carve-out medications. See the list below. For questions or authorizations regarding these drugs, please contact Magellan Medicaid Administration at 877.864.9014. Carve Out Medications as of 04/01/2013 Carve Out Medication Drug Categories as of 04/01/2013 Fill our the Medical Exception for Medication form Pharmacy PA Form and fax back to our localized Pharmacy Department at 517.364.8413. The Pharmacy PA Form is in Adobe Acrobat format and may be printed to be filled out by hand then faxed back to us. Be sure to include the Physician's signature before faxing.

	Prescription Benefits

Outlined below are the current options available to employer groups who purchase a prescription drug benefit from PHP. Several copayment combinations are offered within each of these options. Please call PHP Customer Service at 517.364.8500 or 800.832.9186 if you are unsure of which benefit you have, or if you would like to check your copayments. Single-Tier Benefit On the single-tier benefit, you have one co-payment for brand-name or generic drugs on the PDL. Prescription drugs that are not on the PDL are not covered unless prior approval is granted. Be certain to ask your doctor to prescribe a medication that is on the PDL whenever possible. Most Single-Tier Benefits have an ancillary fee for brand-name medications that have a generic available. Two-Tier Benefit There are two copayments available on the two-tier benefit. Generic drugs (first tier) on the PDL will always have the lowest copayment, and brand-name drugs (second tier) on the PDL have the higher copayment. If you are prescribed a brand-name drug that has a generic available, you can choose the lower copayment by opting for the generic drug. If you select a brand-name drug on the PDL, you will pay the higher copayment. Prescription drugs not on the PDL are not covered unless prior approval is granted. You can request that your doctor consider prescribing a medication that is on the PDL. Three-tier Benefit The three-tier benefit has three different copayment options. Generic medications on the PDL have the lowest copayment. If you are prescribed a brand-name drug that has a generic available, the generic must be dispensed to receive the lowest (first tier) copayment. If you select a brand-name drug on the PDL, you will pay a higher copayment (second tier). With a three-tier benefit, you have access to almost all FDA approved prescription drugs - even those not on the PDL. However, you will pay the highest copayment for any drugs not on the PDL (third tier). When your doctor prescribes medications from the PDL, you receive the most value from your prescription drug benefit. Outlined below are the current options available to employer groups who purchase a prescription drug benefit from PHP. Several copayment combinations are offered within each of these options. Please call PHP Customer Service at 517.364.8500 or 800.832.9186 if you are unsure of which benefit you have, or if you would like to check your copayments. Single-Tier Benefit On the single-tier benefit, you have one co-payment for brand-name or generic drugs on the PDL. Prescription drugs that are not on the PDL are not covered unless prior approval is granted. Be certain to ask your doctor to prescribe a medication that is on the PDL whenever possible. Most Single-Tier Benefits have an ancillary fee for brand-name medications that have a generic available. Two-Tier Benefit There are two copayments available on the two-tier benefit. Generic drugs (first tier) on the PDL will always have the lowest copayment, and brand-name drugs (second tier) on the PDL have the higher copayment. If you are prescribed a brand-name drug that has a generic available, you can choose the lower copayment by opting for the generic drug. If you select a brand-name drug on the PDL, you will pay the higher copayment. Prescription drugs not on the PDL are not covered unless prior approval is granted. You can request that your doctor consider prescribing a medication that is on the PDL. Three-tier Benefit The three-tier benefit has three different copayment options. Generic medications on the PDL have the lowest copayment. If you are prescribed a brand-name drug that has a generic available, the generic must be dispensed to receive the lowest (first tier) copayment. If you select a brand-name drug on the PDL, you will pay a higher copayment (second tier). With a three-tier benefit, you have access to almost all FDA approved prescription drugs - even those not on the PDL. However, you will pay the highest copayment for any drugs not on the PDL (third tier). When your doctor prescribes medications from the PDL, you receive the most value from your prescription drug benefit.

	How to Reach Us

For questions and/or concerns for the Pharmacy Department regarding a medication and/or authorization for medication you can contact the staff via email or you can call during normal business hours: Monday through Friday from 8:00 a.m. – 5:00 p.m. The toll free line is: 877.205.2300 The local line is: 517.364.8545 •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. For questions and/or concerns for the Pharmacy Department regarding a medication and/or authorization for medication you can contact the staff via email or you can call during normal business hours: Monday through Friday from 8:00 a.m. – 5:00 p.m. The toll free line is: 877.205.2300 The local line is: 517.364.8545 •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.