Drug Formularies: Members

Introduction
A Drug Formulary is a list of medications that are “recommended” for use. The HealthPlus Drug Formularies are developed in committee by practicing physicians and pharmacists . If you want to look at the formulary, you can do a customized search for a drug to receive up-to-date information based on your own benefit, or you can view or print general formulary documents.

To receive the most current and up-to-date information about your pharmacy benefit and the formulary, you have access to a customized search tool that provides information based on your specific benefit. If you would like to do a customized search, please click on the link below to log in through the on-line service center. When you log in, this allows the system to pull information based on your specific benefit (copays, formulary tiers, limitations and exclusions, deductibles, etc.). When you search for a drug, you will receive information that tells you if the medication is on formulary or non-formulary (non-formulary medications are still a covered benefit, unless there are restrictions noted), and if the medication is generically available. You can do a price quote to find out your cost for a specific drug (based on your copays and benefit). You can find out if there are restrictions on a medication, and you can view other medications that are similar.

My Drug Costs, the Formulary and More
If you would like to view or print formulary listings, please select the specific Drug Formulary and click on the document you would like to view.

PLEASE NOTE: You must have Adobe Acrobat installed in order to access the PDF files below. Please take a moment to download this FREE software if you do not already have it.

Then, select the specific Drug Formulary below and click on the document that you would like to view. After opening the document, click on the binoculars icon to search for a drug. You may search by brand name or generic name. If you are unsure of the spelling, you may use the first few letters of the word. If you are unable to find a drug, please contact the HealthPlus Customer Service Department at (800) 332-9161 for more information.

Please select the specific Drug Formulary and click on the document you would like to view:

HealthPlus Commercial/Medicare/PPO Drug Formulary
The HealthPlus Commercial/Medicare/PPO Drug Formulary is an open formulary with restrictions. An “open formulary” means that medications that are not listed on the formulary are still a covered benefit (subject to applicable limitations and exclusions). “Restrictions” means that some medications may require prior authorization before the medication is covered by HealthPlus, based on criteria or medical necessity. Please see the sections in the complete HealthPlus Drug Formulary for a description of the Prior Authorization Program, Pharmacy Prior Authorization Form and Prior Authorization Criteria. To ensure that members never go without medication, pharmacies may dispense a starter dose for up to 7 days for any medication that requires prior authorization.
Click here for the HealthPlus Formulary Quick Check
Click here for the complete HealthPlus Drug Formulary

HealthPlus Three-Tier Drug Formulary
The Three Tier Drug Benefit design has three copayment levels based on the type of medication purchased. The tier in which your prescription drug falls determines your copayment:

Tier 1 (lowest copayment)= Generic drugs
Tier 2 (medium copayment)= Formulary or preferred brand drugs
Tier 3 (highest copayment)= Non-formulary or non-preferred brand drugs

Some medications may require prior authorization before the medication is covered by HealthPlus, based on criteria or medical necessity. Medications that require prior authorization have a (PA) symbol after the name of the medication in the documents below. Please see the sections in the complete HealthPlus Drug Formulary (above) for a description of the Prior Authorization Program, Pharmacy Prior Authorization Form and Prior Authorization Criteria. To ensure that members never go without medication, pharmacies may dispense a starter dose for up to 7 days for any medication that requires prior authorization.

Click here for the complete HealthPlus Three Tier Benefit-Prescription Drug List

Click here for a list of medications in the third tier (highest copay). This list is sorted alphabetically on the first page, and by drug class on the second page.

HealthPlus Partners (Medicaid) Drug Formulary
The HealthPlus Partners (Medicaid) Drug Formulary is an open formulary with restrictions. An “open formulary” means that medications that are not listed on the formulary are still a covered benefit (subject to applicable limitations and exclusions). “Restrictions” means that some medications may require prior authorization before the medication is covered by HealthPlus, based on criteria or medical necessity. For a list of medications that require Prior Authorization and alternatives, please see the HealthPlus Partners Prior Authorization Quick Check. To ensure that members never go without medication, pharmacies may dispense a starter dose for up to 7 days for any medication that requires prior authorization.
Click here for the HealthPlus Partners Prior Authorization Quick Check

HealthPlus County Health Plan (Genesee, Saginaw, Bay) Drug Formulary
The HealthPlus County Health Plan Drug Formulary is a closed formulary. A “closed” formulary means that coverage is limited to products that are listed on the formulary. If a physician prescribes a non-formulary medication, an alternative formulary medication will be recommended when possible. In cases of medical necessity, non-formulary products are covered with prior authorization only. For a list of the medications that are covered for County Health Plan members, please see the County Health Plan Selected Drug Category Reference, or the complete County Health Plan Drug Formulary. To ensure that members never go without medication, pharmacies may dispense a starter dose for up to 7 days for any medication that requires prior authorization.

Click here for the County Health Plan Selected Drug Category Reference
Click here for the complete County Health Plan Drug Formulary