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- Preferred Drug List (Formulary)
- Specialty Drugs
- Mail Order Pharmacy
- Benefits
Preferred Drug List (Formulary)
What is a preferred drug list (formulary)?
A preferred drug list is a list of drugs that are covered at the highest level by our health plans. Think of a formulary as a medicine chest. You wouldn't think of stocking your medicine chest with all available products. Instead, you choose what you think would be best for different uses. At HealthPartners, we choose medications that have been demonstrated to be safe, effective and affordable. (Being on the preferred drug list does not guarantee that a particular drug will be covered under all circumstances.)
Who decides what's in our preferred drug list?
Thousands of medications are available in the United States, including brand-name drugs, generic equivalents and various doses and formulations. Not every drug on the market is appropriate for everyone. Nor are the heavily advertised new drugs necessarily any better than what's already available. That's why HealthPartners looks to clinical experts to determine what to stock in our preferred drug list. Decisions on which drugs to include in the HealthPartners preferred drug list are made by the physicians and pharmacists on our Pharmacy and Therapeutics Committee. The committee develops, manages, updates and administers our preferred drug list.
How is the decision made to include a drug on our preferred drug list?
The Pharmacy and Therapeutics Committee meets regularly to review new drugs on the market and drugs suggested by HealthPartners' physicians. These experts look at effectiveness, safety, side effects and other criteria, such as ease of use. Only after considering all those factors do they look at cost. To maximize your purchasing power, the Committee tries to include on the formulary the least costly alternative among drugs that are otherwise medically equivalent.
How often do drugs get reviewed for the preferred drug list?
We continually update the list of medications. We want our preferred drug list to have the newest advances in effective drug therapy.
Why does HealthPartners use a preferred drug list?
Using a preferred drug list not only serves to protect you from unsafe products, but it also helps us to use your premium dollars responsibly. With pharmaceutical costs skyrocketing and pharmaceutical companies advertising heavily to drive up consumer demand for new products, the savings achieved by using a preferred drug list are critical in keeping your premiums affordable, while providing the best care.
Do I have access to medications that are not on the formulary?
In some cases, you may need a drug that is not on the formulary. Your doctor can request that an exception be made so the nonformulary item can be covered. The clinical pharmacy staff reviews all these requests and decides when an exception is warranted for coverage. Generally, the decision will be made the same day as the request was made by your doctor.
What if my physician prescribes a drug that is not in the HealthPartners formulary?
Doctors don't always remember to prescribe from a particular health plan's formulary. When your personal physician prescribes something for you, you may want to ask if the medication is on the HealthPartners formulary. If it isn't, you may want to ask your physician whether a formulary item would be suitable for you.
Why do some drugs require prior approval (PA)?
For certain drugs, the Pharmacy and Therapeutics Committee has developed criteria that must be met before the drugs will be approved for coverage, even if it is on the formulary. Your doctor will request coverage for these drugs on your behalf. Generally, the decision will be made the same day the request is made by your doctor. These drugs are noted on the formulary with a "PA" after their names.
What is Step Therapy?
For some conditions, your doctor will need to prescribe one medication before trying another – to use "Drug A" before trying "Drug B," in other words. This sequential approach is called "Step Therapy." If "Drug A" doesn't work for you, then your doctor may prescribe "Drug B," and coverage for "Drug B" will automatically be approved for you at the pharmacy. If "Drug A" has not already been prescribed for you, your doctor will need to specifically request coverage of "Drug B" on your behalf. Generally, the decision as to whether that medication will be covered will be made the same day the request was submitted. Step Therapy medications are noted on the formulary with an "ST" after their names.
What does the $ symbol mean on the formulary?
The "$" symbol next to the medication name in the online HealthPartners formulary indicates the average retail price you would pay for a typical prescription quantity, excluding any pharmacy benefit you may have. The price listed for long-term-use medications is for a 30-day supply. All prices reflect the most recent data from actual medication use.
Specialty Drugs
What is CuraScript?
CuraScript is a nationwide specialty pharmacy provider with six pharmacy locations across the country.
What is CuraScript's philosophy?
CuraScript aims to improve outcomes and reduce the cost of care for members with serious or chronic medical conditions. CuraScript works in partnership with patients, families, physicians, health plans and other health care providers to help accomplish this goal. As drug and health care costs continue to rise, CuraScript helps maximize cost savings, improve outcomes and enhance the quality of life of patients with chronic medical conditions.
What services does CuraScript provide?
CuraScript specializes in medications that are prescribed for uncommon diseases. Because CuraScript dispenses these medications daily, they have more experience with them than most local pharmacies or any mail order services and are better able to answer patient questions. They also regularly stock these medications; most local pharmacies need to special order them. CuraScript is also staffed to counsel and educate patients about using injectable medications properly. In addition to having nurses and pharmacists on staff during regular business hours, CuraScript provides emergency access to a pharmacist by phone 24 hours a day, seven days a week. To contact CuraScript, call 877-696-5247.
How do I obtain my prescriptions from CuraScript or HealthPartners Riverside Pharmacy?
The specialty medications will be delivered to your home, to a place of your choice or to your physician's office, depending on the type of medication. A representative from CuraScript or HealthPartners Riverside Pharmacy will call you or your physician to arrange the delivery.
Should I ask for anyone specific at CuraScript or HealthPartners Riverside Pharmacy?
CuraScript has a team dedicated to HealthPartners members and can be reached at 877-696-5247. HealthPartners Riverside Pharmacy has staff dedicated to HealthPartners members receiving growth hormone and can be reached by calling 612-371-1726.
Are doctors aware of this new policy?
Doctors who prescribed these specialty medications have received a letter asking them to help make this transition as smooth as possible for members. Physicians who have not prescribed these medications may not be aware of this policy.
How will the specialty medications be delivered?
FedEx will deliver it in most cases.
Mail Order Pharmacy
Do you have a mail order pharmacy?
Yes. Call 952-833-0497 or 888-356-6656 or use the online prescription refill service at HealthPartners.com/mailorder.
Can I refill prescriptions online?
Yes. Use our online prescription refill service at HealthPartners.com/mailorder to have prescriptions mailed directly to you.
How can members get started with mail order?
Members can call the Mail Order Customer Service Department at 888-356-6656 or 952-833-0497, Monday through Friday, 7 a.m. until 6 p.m., and Saturday, 8 a.m. until 4 p.m. CST, and our Customer Service Representatives will assist new customers in getting started. Or mail your new written prescription in the self-addressed HealthPartners Mail Order envelope with completed forms. It is also easy to transfer a prescription from your local pharmacy by giving us the information from the prescription label.
Are there any savings to using the mail order pharmacy?
Many HealthPartners members have a benefit allowing patients to receive a three-month supply for two copays. Others without the mail order benefit receive prescriptions mailed to their home without a delivery charge. Obtaining a three-month supply is more economical than three separate monthly purchases.
What forms of payment are accepted?
MasterCard, Visa, Discover or American Express are preferred for member/patient convenience. Payment is required prior to shipping. Checks are accepted for the amount of the order, but the exact amount for a check may be difficult to predict.
How long does it take to receive an order?
Prescription refills are processed and mailed within one business day (24 hours).New prescriptions are processed and shipped within three days. Prescriptions requiring intervention are processed and shipped within five days.
Is there any added cost to use mail order?
No, there is no additional charge for postage or handling.
Can prescriptions be transferred from another pharmacy – either from a HealthPartners Clinic or an outside pharmacy?
Yes, members can call the Mail Order Pharmacy directly with the prescription numbers they wish to transfer, the pharmacy to contact, payment and insurance information, allergies, mailing address and other information. You can also transfer your prescriptions online.
How do members get refills on mail order prescriptions?
Refills can also be ordered online at HealthPartners.com/mailorder. Refills may be ordered on our Automated Refill line, 24 hours a day, seven days a week, by calling 800-591-0011 and using a credit card. Refills also may be ordered by mailing an order form or calling Mail Order Customer Service directly. If no refills are available, the mail order pharmacy will contact the provider for authorization.
How are mail order prescriptions shipped?
Mail Order prescriptions are routinely shipped via first class U.S. Postal Service.
How do members find out if they have a Mail Order Pharmacy benefit?
All benefit questions should be directed to HealthPartners Member Services at 952-883-5000 or 800-883-2177.
What if medications are needed before an order arrives in the mail?
HealthPartners Clinic Pharmacies can dispense a 30-day supply. Pharmacy staff will work with Pharmacy Administration Customer Service to get a phone authorization for a 30-day supply at your local pharmacy.
Can items requiring refrigeration be ordered through HealthPartners Mail Order Pharmacy?
Yes. These items are shipped in insulated packaging on ice through United Parcel Service.
Can a provider call a prescription directly to the mail order pharmacy?
In order to fill a mail order prescription, payment and insurance information, address verification, medication allergies and other information are required. The most efficient way to obtain this information is to have the patient mail the new prescription with a completed mail order form. New prescriptions should be given to the patient in order for him or her to mail them with the other information.
For refills, does a provider have to write a new prescription each time a refill authorization is needed?
No – the Mail Order Pharmacy contacts providers for refill authorizations for our members/patients.
What if I have questions about my medication?
You can call our Mail Order Customer Service Department at 952-833-0497 or 888-356-6656 and they will transfer you to one of our pharmacists to answer any questions you have.
What happens if I have a drug therapy question after hours?
A pharmacist is always available to answer drug therapy questions Monday Friday 7 a.m. to 6 p.m., and Saturday 6 a.m. to 4 p.m. If you have a question after these hours you have the options of leaving a message for the pharmacist to call you back the next business day or, connecting to the 24-hour nurse care line through our automated telephone answering system. Please dial 1-800-591-0011 and follow the prompts. If you have a medical emergency dial 911.
Can I have my medication sent to an address other than my home address?
Yes. Let the Customer Service Representative know the address you want the medication shipped to, or make note of the address when you send in the mail order form.
How do I check the status of my prescription?
You can check the status on the web at HealthPartners.com/mailorder or call our Mail Order Customer Service Department at 952-833-0497 or 888-356-6656 and one of our representatives will let you know the status of your prescription or you can also check online.
Benefits
Can I get reimbursed for drugs I get from an out-of-network pharmacy?
Unless you have an out-of-network option, prescriptions must be written by a network physician and be on our formulary. If you have an established drug regimen before joining HealthPartners, you may request non-formulary drugs to ensure continuity of care.
Can I refill medications prescribed before I joined the plan?
Unless you have an out-of-network option, prescriptions must be written by a network physician and be on our formulary. To ensure continuity of care, if you have an established drug regimen before joining HealthPartners, you may request non-formulary drugs.
Log on to your secure member site to view your specific benefits. You also may check your Membership Contract or Summary Plan Description or e-mail Member Services.
I travel. How can I get an extra supply of my medications?
While traveling, you can fill your prescriptions at pharmacy chains that participate in the HealthPartners National Pharmacy Network. (PDF)
Who do I contact with questions about my prescriptions or benefits?
For questions about specific prescriptions, contact the doctor who prescribed them.
For questions about pharmacy benefits, call HealthPartners Member Services at 952-883-5000 or 800-883-2177. Members with hearing impairments may call our TTY line at 952-883-5127.
For questions about ordering prescriptions for selected specialty medications, call CuraScript at 877-696-5247.
For questions about ordering growth hormone prescriptions, call HealthPartners Riverside Pharmacy at 612-371-1726.
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