If you continue using one of the drugs listed below and identified as a Formulary Drug Removal after this date, you may be required to pay the full cost. ����M[ǩш5�o�[E��9g͜�\�z0fK\�E Page 2 of 170 Formulary 600-HA002 Washington Department of Corrections (December 2019) DOC Formulary Comprehensive Drug List (List of Covered Drugs) WellCare of Nebraska – Children’s Health Insurance Plan (CHIP) 00 Please read: This document contains information about the drugs we cover in this plan. Health insurance companies use a formulary system to help control costs while providing safe, effective medications. FORMULARY . endstream endobj startxref The Formulary List may not include all drugs covered by your prescription drug benefit. The Formulary List may not include all drugs covered by your prescription drug benefit. Please note that the Nebraska CHIP Drug List is updated quarterly. The Ambetter from Peach State Health Plan Formulary, or Preferred Drug List, is a guide to available brand and generic drugs that are approved by the Food and Drug Administration (FDA) and covered through your prescription drug beneft. A formulary is a listing of brand name and generic medications that are preferred by your insurance company.

Note: Appendices II – Formulary Drug Listings and IV – Alternate Choices for Non-formulary Medications may be updated frequently as clinical data or contract prices change. Last Update: September, 2020. Coverage is not provided for Prescription Drugs and Over-the-Counter Drugs not appearing on the Formulary drug list, unless an exception has been granted by the Plan pursuant to the Step Therapy Program. NOTE: Nebraska CHIP was formerly named Nebraska Family Planning. endstream endobj 1139 0 obj <>>>/Filter/Standard/Length 128/O(P��"�!a.��y��~�6�9V�\\���a+��)/P -1340/R 4/StmF/StdCF/StrF/StdCF/U(+��k��\\��\\�$R3nG )/V 4>> endobj 1140 0 obj <>/Metadata 27 0 R/Pages 1136 0 R/StructTreeRoot 31 0 R/Type/Catalog>> endobj 1141 0 obj <>/MediaBox[0 0 612 792]/Parent 1136 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1142 0 obj <>stream Over-the-counter medications are non-formulary as well.If you are prescribed a medication that is non-formulary, talk to your doctor to see if a different medication on the formulary would work just as well. Medications not on the list are considered non-formulary.Your non-formulary prescription may be covered by insurance based on the type of formulary your insurance company uses. %%EOF
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%PDF-1.6 %���� An "open" formulary allows coverage for most drugs; however, you will have to follow the procedures and meet the criteria established by the insurance company to obtain coverage for a non-formulary drug. The group members, who typically do not work for the entity that requires the formulary, review new and current medications and make their formulary selections based on patient demographics, the effectiveness and safety of the drugs, and their costs. 2019 National Formulary Effective 01/01/2019 The Formulary List is a guide providing tier designation for common medicines within select therapeutic categories. Medications that are not FDA-approved are non-formulary as are FDA-approved drugs that are prescribed for purposes other than what they were approved for. You may also request an exception from your insurance company for the non-formulary drug. The list contains information about how the drugs are made and why they are used. This list is effective January 1, 2015. Other insurance companies will pay a small amount towards a non-formulary drug. Generic medicines are available within An exception occurred while searching for this drug. Drug name. Generic medicines are available within 0 Her articles have appeared in "The Florida Times-Union" and Guideposts "Angels on Earth" Magazine. Non-Formulary drugs are not on the Formulary drug list.