Presbyterian Health Plan | Summer 2019 | Your Story

6 Your prescription drug coverage Your prescription drug benefits offer you cost-effective drug coverage, safety, and quality. If you have prescription drug coverage with your plan, generally your benefits cover: ● ● Generic and brand name drugs listed on our Formulary or Preferred Drug List ● ● Certain specialty drugs Why dowe have a Formulary or Preferred Drug List? Having a Formulary (a Preferred Drug List of covered drugs) helps us keep your out-of-pocket costs down. The list contains thousands of drugs and is reviewed and updated by a committee of healthcare providers and pharmacists. Ask your provider to use the health plan Formulary when choosing drugs to treat your health condition or disease. The Formulary includes notes on a drug’s restrictions or requirements, such as prior authorization, step therapy, quantity limits, and limits on dosage forms and/or strengths. You can find the drug Formulary or Preferred Drug List at www.phs.org . Why do some drugs have restrictions? Some covered drugs may have additional requirements to ensure you are getting the safest and best drug for your health condition or disease, while keeping your cost at a minimum. When a drug needs a prior authorization, we make every effort to review each request as quickly as possible. Reviews are generally completed within 24 to 48 hours when all of the required medical information is included with the request. If you need a drug that is not on the Formulary, you or your provider can request an exception. We look at the request and work with your provider to determine if the drug is medically necessary. Our clinical pharmacists are available to help you and your provider to find a Formulary drug that works for your health condition and to find less expensive generic drugs instead of using a brand name. To ask for an exception to the Formulary, you can call the Presbyterian Customer Service Center at the phone number on your member ID card. You may also submit an exception request online at www.phs.org/mypres . Log in to myPRES and select “Access MyPharmacy” to find the “My Medicine Cabinet” home page. Select “Member Tools” and then “Drug List” from the tool bar. Click on the hyperlink to submit an Exception Request. Please note, the first time you follow these steps you will be asked to register with OptumRx for a Healthsafe ID. Presbyterian partners with OptumRx to provide pharmacy benefits information. Future visits will go faster. You can find the drug Formulary or Preferred Drug List at www.phs.org . The drug formulary is under the Large Group Plans and Health Insurance Exchange Metal Level Plans. Presbyterian Health Plan online provider directory Presbyterian Health Plan has a web-based provider directory on www.phs.org . Choose “Find a Doctor” in the red box on the right of the screen. Both members and nonmembers can search for providers using this online tool. In the directory, you can find the following information: • Name • Gender (male/female) • Specialty • Hospitals where they practice • Board certification • If they are accepting new patients • Languages they speak in the office • Office locations and phone numbers You can search on one or more of the items listed above. To get all of the information you want, fill in as many blanks as you want on the search page. The search page has instructions for both smartphone users and computer users. You can also get provider information on paper or by phone by calling the Presbyterian Customer Service Center at the number on the back of your member ID card.