If you have need for DME, a separate referral and approval to a participating provider is necessary. Any additional services that would normally require authorization would need a separate, new authorization that should be coordinated through your Primary Care Physician. Many times the issue can be handled immediately. If not, the Member Service Representative will assist you to get your concern resolved as soon as possible. The formulary is revised quarterly to evaluate new medicines and also those already covered on the formulary.
Preferred drugs are available at the lower co-pays.
This decision is made by a panel of physicians who consider first the scientific information available about the safety and effectiveness of a particular drug vs. alternative drugs, and then cost factors. This is an important benefit for members considering the speed with which new drugs are entering the market and the numerous reports of side effects with the newer medicines. The formulary decisions are based on the latest available scientific information. You would be prior authorized for a period of time in this case to continue to receive such a drug when used to treat an on-going condition. Member Services can advise you if necessary about this period of time and when it expires.