Not all pharmacy plans cover the same medications or cover the same medications in the same way. The price your patient pays will depend on the pharmacy plan they belong to, as well as the medication you prescribe.

Non-Formulary Medications

• Any medication not listed on the PML is non-formulary
• If your patient has a three-tier prescription benefit, non-formulary medications are only available at the highest copayment
• If your patient has a closed formulary benefit, non-formulary medications are only available at the member's expense

National Provider Identifier Number (NPI) and Claim Adjudication

When pharmacists transmit prescriptions electronically, the provider's NPI number is transmitted, not the provider name. It is important that the pharmacy have the correct provider NPI number associated with the prescription.

Downloadable Forms

The following forms are available to download:

• Specialty Forms
• Mail Order Forms
• Medication Prior-Authorization Form
• Authorizations for Use and Disclosure of Protected Health Information

Information on Generics
Help control rising health care costs by prescribing generic medications wherever possible.

Medication Policies
Medication Policies have been developed through consideration of medical necessity, generally accepted standards of medical practice, and review of medical literature and government approval status.