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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.
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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 any notes & restrictions.
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 notes & restrictions section of your search results.
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.
Definition of Symbols
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Tier 1 |
Lowest copay. Generics are often placed in this tier. |
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Tier 2 |
Middle copay. Formulary brands are often placed in this tier. |
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Tier 3 |
Third tier copay. Non-formulary brands are often placed in this
tier. |
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Specialty Drugs |
Specialty drugs are generally injectable, high cost medications
that have special handling requirements or require special training before use.
Some oral chemotherapy drugs are specialty drugs. |
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Generic Drug |
Medications that have generic equivalents are covered at a
generic reimbursement level, and should be prescribed and dispensed in
the generic form. |
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Step Therapy |
Some drugs require the use of an appropriate alternative
therapy within a specified number of days before they can be covered
by the plan. |
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Quantity Limit |
Some medications may be subject to quantity level limits
based on the manufacturer's packaging size or adopted clinical guidelines. |
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Prior Authorization |
To promote the most appropriate utilization, selected
high-risk or high-cost medications require a prior authorization by
the health plan to be eligible for coverage. |
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Member Note |
Special notes or instructions. |
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