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(List of Covered Drugs) - mdaprograms.com

SilverScript2018 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINSINFORMATION ABOUT THE DRUGS WE COVER IN THIS PLANF ormulary File 18419, Version 5 This formulary was updated on August 1, 2017. For more recent information or other questions, pleasecontact SilverScript at 1-866-235-5660 or, for TTY users, 711, 24 hours a day, 7 days a week, or to existing members: This formulary has changed since last year. Please review this document tomake sure that it still contains the drugs you this drug list (formulary) refers to we, us, or our, it means SilverScript Insurance Company. Whenit refers to plan or our plan, it means SilverScript Choice (PDP).This document includes a list of the drugs (formulary) for our plan which is current as ofJanuary 1, 2018. For an updated formulary, please contact us. Our contact information, along with the datewe last updated the formulary, appears on the front and back cover must generally use network pharmacies to use your prescription drug benefit.

SilverScript 2018 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary File 18419, Version 5

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Transcription of (List of Covered Drugs) - mdaprograms.com

1 SilverScript2018 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINSINFORMATION ABOUT THE DRUGS WE COVER IN THIS PLANF ormulary File 18419, Version 5 This formulary was updated on August 1, 2017. For more recent information or other questions, pleasecontact SilverScript at 1-866-235-5660 or, for TTY users, 711, 24 hours a day, 7 days a week, or to existing members: This formulary has changed since last year. Please review this document tomake sure that it still contains the drugs you this drug list (formulary) refers to we, us, or our, it means SilverScript Insurance Company. Whenit refers to plan or our plan, it means SilverScript Choice (PDP).This document includes a list of the drugs (formulary) for our plan which is current as ofJanuary 1, 2018. For an updated formulary, please contact us. Our contact information, along with the datewe last updated the formulary, appears on the front and back cover must generally use network pharmacies to use your prescription drug benefit.

2 Benefits, formulary,pharmacy network, and/or copayments/coinsurance may change on January 1, 2019, and from time to timeduring the AcceptedFRM-CM-CHC-9110-18 What is the SilverScriptFormulary?A formulary is a list of Covered drugs selected bySilverScript Choice (PDP) in consultation with ateam of health care providers, which representsthe prescription therapies believed to be anecessary part of a quality treatment plan will generally cover the drugs listed inour formulary as long as the drug is medicallynecessary, the prescription is filled at a plannetwork pharmacy, and other plan rules arefollowed. For more information on how to fill yourprescriptions, please review your Evidence the Formulary ( drug list)change?Generally, if you are taking a drug on our 2018formulary that was Covered at the beginning ofthe year, we will not discontinue or reducecoverage of the drug during the 2018 coverageyear except when a new, less expensive genericdrug becomes available or when new adverseinformation about the safety or effectiveness of adrug is types of formulary changes, such asremoving a drug from our formulary, will not affectmembers who are currently taking the drug .

3 It willremain available at the same cost-sharing forthose members taking it for the remainder of thecoverage feel it is important that you have continuedaccess for the remainder of the coverage year tothe formulary drugs that were available when youchose our plan, except for cases in which you cansave additional money or we can ensure we remove drugs from our formulary, add priorauthorization, quantity limits and/or step therapyrestrictions on a drug , or move a drug to a highercost-sharing tier, we must notify affectedmembers of the change at least 60 days beforethe change becomes effective, or at the time themember requests a refill of the drug , at whichtime the member will receive a 60-day supply ofthe the Food and drug Administration deems adrug on our formulary to be unsafe or the drug smanufacturer removes the drug from the market,we will immediately remove the drug from ourformulary and provide notice to members whotake the enclosed formulary is current as of January1, 2018.

4 To get updated information about thedrugs Covered by SilverScript Choice (PDP),please contact us. Our contact informationappears on the front and back cover we have other types of mid-yearnon-maintenance formulary changes unrelated tothe reasons stated above ( remove drugsfrom our formulary, add prior authorizationrequirements, quantity limits and/or step therapyrestrictions on a drug , or move a drug to a highercost-sharing tier), we will notify you by mail. Wewill also update our formulary with the newinformation. The updated formulary may beobtained from our website or by calling us. Ourcontact information appears on the front and backcover do I use the Formulary?There are two ways to find your drug within theformulary:Medical ConditionThe formulary begins on page 8. The drugs in thisformulary are grouped into categories dependingon the type of medical conditions that they areused to treat. For example, drugs used to treat aheart condition are listed under the category, Cardiovascular.

5 If you know what your drug isused for, look for the category name in the listthat begins on page 8. Then look under thecategory name for your ListingIf you are not sure what category to look under,you should look for your drug in the Index thatbegins on page 53. The Index provides analphabetical list of all of the drugs included in thisdocument. Both brand name drugs and genericdrugs are listed in the Index. Look in the Indexand find your drug . Next to your drug , you will seethe page number where you can find coverageinformation. Turn to the page listed in the Indexand find the name of your drug in the first columnof the are generic drugs?SilverScript Choice (PDP) covers both brandname drugs and generic drugs. A generic drug isapproved by the FDA as having the same activeingredient as the brand name drug . Generally,generic drugs cost less than brand name there any restrictions onmy coverage?Some Covered drugs may have additionalrequirements or limits on coverage.

6 Theserequirements and limits may include:Prior Authorization (PA)SilverScript Choice (PDP) requires you or yourphysician to get prior authorization for certaindrugs. This means that you will need to getapproval from us before you fill yourprescriptions. If you don t get approval, we maynot cover the Limits (QL)For certain drugs, SilverScript Choice (PDP)limits the amount of the drug that we will example, our plan provides up to 30 tabletsper prescription for doxazosin. This may be inaddition to a standard one-month or Therapy (ST)In some cases, SilverScript Choice (PDP)requires you to first try certain drugs to treat yourmedical condition before we will cover anotherdrug for that condition. For example, if drug Aand drug B both treat your medical condition, wemay not cover drug B unless you try drug A drug A does not work for you, we will thencover drug can find out if your drug has any additionalrequirements or limits by looking in the formularythat begins on page 8.

7 You can also get moreinformation about the restrictions applied tospecific Covered drugs by visiting our website. Wehave posted on line documents that explain ourprior authorization and step therapy may also ask us to send you a copy. Ourcontact information, along with the date we lastupdated the formulary, appears on the front andback cover can ask us to make an exception to theserestrictions or limits or for a list of other, similardrugs that may treat your health condition. Seethe section, How do I request an exception to theSilverScript formulary? on page 3 for informationabout how to request an if my drug is not on theFormulary?If your drug is not included in this formulary (list ofcovered drugs), you should first contact CustomerCare and ask if your drug is you learn that SilverScript Choice (PDP) doesnot cover your drug , you have two options:lYou can ask Customer Care for a list ofsimilar drugs that are Covered by our you receive the list, show it to yourdoctor and ask him or her to prescribe asimilar drug that is Covered by our can ask us to make an exception andcover your drug .

8 See below forinformation about how to request do I request an exceptionto the SilverScript Formulary?You can ask us to make an exception to ourcoverage rules. There are several types ofexceptions that you can ask us to can ask us to cover a drug even if it isnot on our formulary. If approved, thisdrug will be Covered at a pre-determinedcost-sharing level, and you would not beable to ask us to provide the drug at alower cost-sharing can ask us to cover a formulary drugat a lower cost-sharing level if this drug isnot on the specialty tier. If approved thiswould lower the amount you must pay foryour can ask us to waive coveragerestrictions or limits on your drug . Forexample, for certain drugs, our plan limitsthe amount of the drug that we will your drug has a quantity limit, you canask us to waive the limit and cover agreater , SilverScript Choice (PDP) will onlyapprove your request for an exception if thealternative drugs included on the plan s formulary,the lower cost-sharing drug or additionalutilization restrictions would not be as effective intreating your condition and/or would cause you tohave adverse medical should contact us to ask us for an initialcoverage decision for a formulary, tiering orutilization restriction exception.

9 When yourequest a formulary, tiering or utilizationrestriction exception you should submit astatement from your prescriber or physiciansupporting your , we must make our decision within 72hours of getting your prescriber s supportingstatement. You can request an expedited (fast)exception if you or your doctor believe that yourhealth could be seriously harmed by waiting up to72 hours for a your request to expedite is granted, we mustgive you a decision no later than 24 hours afterwe get a supporting statement from your doctoror other do I do before I can talkto my doctor about changingmy drugs or requesting anexception?As a new or continuing member in our plan youmay be taking drugs that are not on ourformulary. Or, you may be taking a drug that is onour formulary but your ability to get it is example, you may need a prior authorizationfrom us before you can fill your prescription. Youshould talk to your doctor to decide if you shouldswitch to an appropriate drug that we cover orrequest a formulary exception so that we willcover the drug you you talk to your doctor to determine theright course of action for you, we may cover yourdrug in certain cases during the first 90 days youare a member of our each of your drugs that is not on ourformulary or if your ability to get your drugs islimited, we will cover a temporary 30-day supply(unless you have a prescription written for fewerdays) when you go to a network your first 30-day supply, we will not pay forthese drugs, even if you have been a member ofthe plan less than 90 you are a resident of a long-term care facility,we will allow you to refill your prescription until wehave provided you with a 102-day transitionsupply, consistent with the dispensing increment,(unless you have a prescription written for fewerdays).

10 We will cover more than one refill of thesedrugs for the first 90 days you are a member ofour plan. If you need a drug that is not on ourformulary or if your ability to get your drugs islimited, but you are past the first 90 days ofmembership in our plan, we will cover a 34-dayemergency supply of that drug (unless you havea prescription for fewer days) while you pursue aformulary you experience a change in your level of care,such as a move from a home to a long-term caresetting, and need a drug that is not on ourformulary (or if your ability to get your drugs islimited), we may cover a one-time temporarysupply from a network pharmacy for up to 34days unless you have a prescription for fewerdays. You should use the plan s exceptionprocess if you wish to have continued coverageof the drug after the temporary supply is more informationFor more detailed information about yourSilverScript Choice (PDP) prescription drugcoverage, please review your Evidence ofCoverage and other plan you have questions about our plan, pleasecontact us.


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