HealthPlus has developed medication programs to assist members with unique medication needs.
Specialty Injectable Medication Program
Physicians may request medication by completing and faxing a Specialty Injectable Medication Request Form to one of the following specialty pharmacies:
Telephone: (888) 315-3395
Fax: (800) 546-2172
Telephone: (877) 842-5097
Fax: (877) 254-3674
Diplomat Specialty Pharmacy- Flint:
Telephone: (800) 722-8720 or (810) 230-5045
Fax: (810) 732-7021 or (866) 410-3762
Mandatory Specialty Drug Program
This program applies to self-injected medications for rheumatoid arthritis, Hepatitis C, multiple sclerosis and infertility (when applicable).
Members enrolled in this program are required to receive specific self-injected medications from a HealthPlus-contracted specialty pharmacy listed above. This program does not apply to MedicarePlus Advantage Part D.
The specialty pharmacy can also mail the medication directly to a member’s home.
Ask for 90 Rx Program
Through the Ask for 90 Rx program, eligible HealthPlus members may obtain a 90-day supply of medication, with copay savings, from our contracted mail order vendor, Express Scripts or a local participating pharmacy.
Members with a prescription drug benefit in HealthPlus Commercial, HealthPlus Options, HealthPlus MedicarePlus and HealthPlus Insurance Company (PPO) are eligible for Ask for 90, when and where appropriate.
Though Ask for 90 is available in most cases, there are instances in which the Ask for 90 Program is NOT available, such as:
- HealthPlus Partners, MIChild and County Health Plan members
- Medications such as: injectable medications and compounds and injectable diabetic medications glucagon, EpiPen and Imitrex.
For most benefits, the member will pay the same copay for a 90-day supply at a participating local retail pharmacy, as is paid through Express Scripts.
Members enrolled in the Mandatory Ask for 90 Rx Medication Program are required to receive a 90-day supply each time they fill a prescription, for most chronic medications. A 30-day fill is required before the first 90- day fill, to help ensure that the member has been stabilized on the medication and dose.
Medication Therapy Management (MTM) Program
HealthPlus administers a Medication Therapy Management Program for MedicarePlus Advantage Part D that encompasses the required Centers for Medicare and Medicaid Services (CMS) standards.
Pharmacy Audit Program
HealthPlus (or its designee) performs pharmacy audits to help ensure consistent and accurate electronic submission of prescription claims, by the pharmacy network. Prescription claim audits may include a review of utilization by pharmacies, physicians and members. The pharmacy audit program includes desk (paper) audits, onsite audits and an appeals process.
Drug Recall Surveillance Program
When a drug product is recalled or withdrawn from the market due to safety reasons, HealthPlus reviews prescription utilization to identify members who are receiving the drug. HealthPlus notifies members and prescribers affected by the recall, as appropriate.
For more information about HealthPlus medication programs, please contact the HealthPlus Pharmacy Department at (810) 230-2118 or at email@example.com.