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Thursday, August 28, 2008 
Pharmacy:  Drug Formulary

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 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.

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