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Open Medication Guide

3022 Prime Therapeutics LLC 01/18 January 2018 Medication Guide Please consider talking to your doctor about prescribing one of the formulary medications that are indicated as covered under your plan; which may help reduce your out-of-pocket costs. This list may help Guide you and your doctor in selecting an appropriate Medication for you. The drug formulary is regularly updated. Please visit for the most up-to-date information. Contents Introduction ..I Medication list ..II Changes to the formulary ..II Your Share of Expenses ..III Pharmacy Benefits ..III Medications that are not covered ..III Condition Care Rx Program .. IV Generic drugs .. IV Mail Order Pharmacy .. IV Oral Chemotherapy Drugs .. IV Over-the-counter (OTC) medications .. V Preventive Services .. V Immunizations .. V Women s preventive Services .. V Specialty Pharmacy medications .. V Participating Specialty Pharmacy Provider .. VI Three-month supply .. VI Pharmacy Options .. VII Utilization Management Programs.

of the following: Benefit Booklet, Certificate of Coverage, Contract, Member Handbook or prescription drug endorsement. The Open Formulary Medication Guide provides helpful tips on how to make the most of your pharmacy benefits ... The medication has a preferred formulary alternative or over-the-counter (OTC)alternative. ...

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