Using the plan > Prescription Medications and Our Formulary
A formulary is a list of medications available to
your healthcare provider to use in your treatment and covered as a
prescription-drug benefit to you.
The Hometown Health Plan Pharmacy and Therapeutics
Committee, composed of physicians from various medical specialties in our
community, reviews the medications in all therapeutic categories and selects the
agent(s) in each class that meet its criteria for safety, effectiveness, and
cost.
The P&T Committee reviews new and existing
medications regularly to ensure that the Formulary remains responsive to the
needs of our members and providers.
Prescription Copayments (if
applicable)
(Please refer to your Hometown Health Plan
membership card for your plan’s specific copayments.)
Your benefit includes coverage for one course of
treatment or a thirty-day supply for one copayment.
The rising cost of prescription drugs threatens the
ability of employers to offer a pharmacy benefit to their employees. To help our
employer groups face this challenge, Hometown Health has created
pharmacy-benefit designs to control costs while maintaining a choice of quality
pharmaceuticals.
These benefits cover medications at three levels,
also called “tiers.” Each level involves a different amount of out-of-pocket
expense for you, depending on the cost of the medication. The following table
gives you a picture of each level and compares the cost for each level.
|
Level |
Type of drug |
Out-of-pocket cost |
|
1 |
Generic drug on the Formulary |
$ |
|
2 |
Preferred brand-name drug (on Formulary) |
$$ |
|
3 |
Nonpreferred brand-name drug (not on Formulary) |
$$$ |
Members who have a three-level pharmacy benefit
have access to a greater choice in covered prescription drugs. For example, if
you and your provider agree that a brand-name drug that is not on the Formulary
would be more appropriate than a preferred brand-name drug, you could purchase
it by paying a slightly higher copayment. If your pharmacy benefit does not
include this three-level coverage, you would be responsible for the cost of that
drug, as your plan would not cover drugs not on the Formulary. If you present
your Hometown Health membership card, you may receive a discount on that drug.
Please note that your pharmacy benefits may be
different from the approach described here. Please review your Evidence of
Coverage and other plan documents to understand your specific benefits.
Mail Order Program (if applicable)
For prescriptions that you need to take for more
than a 30-day period, Hometown Health Plan offers a mail order prescription drug
program, which provides for your prescription needs and delivers them directly
to your home.
A few points to keep in mind about the mail order
program:
If you are starting a new maintenance medication
therapy or are a new member of Hometown Health Plan, you must first obtain a
30-day supply of medication at your local retail pharmacy. When you and your
doctor are satisfied with the results of your new medication therapy, mail a
second prescription for up to a 90-day supply, with applicable refills, to the
Mail Order Prescription Drug Program.
Controlled substances are not available through the
mail order program. Please contact Hometown Health’s Customer Services
Department if you are prescribed a new medication and you would like to know
whether it is on our Formulary.
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