Using your 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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