Medicare Health Plans >> Can the formulary change?

Medicare Health Plans

Can the formulary change?

What is the Formulary?
A formulary is a list of covered drugs selected by Welborn Health Plans in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Welborn Health Plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Welborn Health Plans network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Can the Formulary change?
Generally, if you are taking a drug on our 2012 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2012 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.If we remove drugs from our formulary, or 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 affected members of the change at least 60 days before 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.

To get updated information about the drugs covered by your plan please visit our Web site at http://www.welbornhealthplans.com/medicare or call Customer Services at 1-800-521-0265, 7 days a week, 8 a.m. to 8 p.m. TTY: 711. Welborn Health Plans’ process for updating print formularies is to use an errata sheet in the event of mid-year non-maintenance formulary changes.