What is the Central Health Medicare Plan Formulary?
A formulary is a list of drugs selected by Central Health Medicare Plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Central Health Medicare Plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Central Health Medicare Plan network pharmacy, and other plan rules are followed.
Central Health Medicare Plan may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
There are two ways to find your prescription drug within the formulary. The drugs are grouped into categories depending on the health condition they treat. For example, if you want to find drugs used to treat a heart condition, you would turn to the category listing and look for "Heart and Circulation."
If you are not sure what category to look under, you should look for your drug in the Index. The Index provides an alphabetical list of all of the drugs included in the drug formulary.
If your drug is not included in the complete formulary, you should talk with your doctor about prescribing a covered drug if it is an acceptable alternative.
Coverage Determination, Grievances, and Appeals
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