|
Pharmacy:
Welcome to the Drug Formulary Page! PHP uses this Drug Formulary as the
cornerstone of drug therapy, quality assurance, and cost containment efforts in
pharmacy services. Hospitals and managed care organizations have used Drug
Formularies for many years to provide comprehensive, cost-effective pharmacy
services. Each benefit plan is uniquely designed according to each employer's
desired benefits. Please refer to your benefit plan for coverage. Drugs not
listed within the formulary on this Web site are considered non-formulary.
If you have any questions, please contact the PHP Customer Service Department
at (260) 432-6690, (800) 982-6257 or (260) 459-2600 for the hearing impaired.
You can also e-mail questions to: custsvc@phpni.com.
PHP Pharmacy Benefits
Physicians Health Plan members have several possible pharmacy prescription
programs (a two-tiered program, a three-tiered program, or an HRA - High Deductible Health Plan program). Please refer to your Summary
of Benefits, Certificate of Coverage, or Member ID Card to determine which
program applies to you and your family. Detailed information of the programs
may be obtained on the Pharmacy page of our
site.
-back to top-
How to use the Online Drug Formulary
To use the online Drug Formulary you must select the Formulary Search option
from the menu. From there you may search any drug either by name or drug class.
Once your search is complete, the screen will show the drug name, the dosage
and strength, the status of the drug and the relative cost.
The relative cost is an indication of the cost of the medication to PHP within
the selected therapeutic category. The greater the number of dollar signs, the
higher the cost. The index reflects the cost/day or cost/prescription based on
normal dosing of the medication. The index does not necessarily reflect the
costs that may be incurred by non-PHP members.
Prior authorization is the request from a doctor for approval before a drug is
dispensed as a covered benefit. If a drug needs prior authorization, this will
also appear in the status section of your search results.
The status of the drug is whether it is approved, needs prior authorization,
etc. A key (example below) is provided under the drug name to explain the
status of the drug.
Please note: a generic drug is only available if the 
symbol appears next to the name. If you have any questions about whether or not
a generic is available, please call PHP Customer Service at (260) 432-6690
or (800) 982-6257.
| Preferred |
|
Preferred over all other drugs in the
same therapeutic category |
| Approved |
|
Approved for reimbursement without
any restrictions |
| Prior Authorization |
|
Reimbursement will be allowed only
when the claim has been submitted to plan officials by a prescriber for review
prior to the issuance of a prescription. |
| Non Formulary |
|
The Plan lists this drug as not on
the formulary. Some plans may reimburse for non formulary drugs and some may
not. Please check your plan's non formulary policy. |
| Not Reimbursed |
|
This drug is not reimbursed by the
plan. |
| Not Listed |
|
No information available for this
drug. It may or may not be reimbursable. Please click on the note icon to view
the plan's policy for not listed drugs. |
| Generic Available |
|
The symbol
after the drug name indicated that the drug has a generic available. PHP
requires that a generic be used in most cases if it is available.
|
-back to top-
|