The HealthPlus Pharmacy Department is an excellent resource for information related to pharmacy locations, mail-order prescription service, HealthPlus drug formularies and other pharmacy-related questions.
HealthPlus works with specialty pharmacies that supply specialty medications at discounted prices.
To help ensure that a member does not go without necessary medications, the pharmacy may dispense up to a seven-day starter dose of the medication for the member, if the physician is unavailable for consult (with no copay for the member). This override is monitored and is subject to a HealthPlus audit.
The pharmacy may also override “non-participating physician” system edits when a prescription is written for an emergency situation or upon discharge from the hospital. This override is monitored and is subject to audit.
Drug formularies provide useful information about generic alternatives, preferred products, step therapy/prior authorization requirements, etc. This information allows physicians to make an informed prescription choice at the point of care, and facilitates increased use of generic drugs, cost-effective alternatives and formulary compliance.
Prior Authorization of Medications
Prior authorization is required for the targeted medications when prescribed more than once daily or when quantity limits are exceeded. Physicians may submit the standard prior authorization request form with information that includes a current diagnosis and medical necessity for the dosage regimen.
HealthPlus promotes the use of generic medications whenever appropriate. The Prior Authorization Program limits Dispense as Written prescriptions for brand name medications, to cases of medical necessity. Prior authorization is required for brand name medications, when a generic equivalent is available. Requests are reviewed through the process listed above.
Benefits and Copays
Prescription drug benefits and copays may vary based upon the member’s benefit level.
For questions related to member benefits and copays, please contact the Customer Service Department at 800-332-9161.
Dose Optimization Program
HealthPlus administers a dose optimization program to target medications that are recommended for once daily dosing and/or support maximum dose recommendations through quantity limits. By optimizing the dose and frequency, patient compliance increases and prescription costs decrease.
NOTE:This program does not apply to MedicarePlus Advantage Part D.
E-Prescribing and Pre-Prescribing
HealthPlus encourages providers to prescribe medications electronically. Ready access to a patient’s medication history is essential to preventing drug duplications, interactions, polypharmacy and more.
Pre-prescribing services are activities performed before a prescription is electronically transmitted to the pharmacy. The following pre-prescribing services are available to physicians through their e-prescribing software for all HealthPlus members:
- Eligibility verification
- Medication history/prescription profile
- Drug formulary/benefit/prior authorization information
You may request a personalized one-on-one pharmacy review with a HealthPlus Pharmacist to identify specific pharmacy opportunities to decrease costs, while maintaining quality. The pharmacist helps to identify cost-savings opportunities by reviewing your personal prescribing patterns.
Drug Utilization Review
HealthPlus administers a comprehensive Drug Utilization Review Program to help ensure the quality and safety of prescribing and dispensing medications to members. The program includes point-of-service quality and safety edits to the pharmacist when a prescription is being filled, and retrospective analysis of claims data to identify opportunities for educational intervention.
For more information, please contact the HealthPlus Pharmacy Department at (810) 230-2118 or at firstname.lastname@example.org.