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Pharmacy:
Select a question from the list below to view the corresponding answer.
What is a formulary?
A formulary is a list of prescription drugs that Physicians Health Plan
encourages their practitioners to prescribe when appropriate. PHP develops this
formulary with the help of PHP doctors and pharmacists. The PHP formulary is
updated quarterly and may change at any time.
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Why does my health plan have a formulary?
Health plans use formularies to manage the cost of pharmaceutical healthcare.
PHP uses guidelines and protocols to encourage physicians to prescribe
according to a predetermined therapeutic strategy developed by our local health
professionals.
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What is a formulary "status"?
A formulary "status" is the means used by PHP to distinguish between drugs on
the formulary. Your doctor uses these statuses to interpret the recommendations
of the Pharmacy & Therapeutics Committee.
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What if my doctor wants to prescribe a non-formulary medication?
Your doctor may prescribe a prescription drug that is not on the PHP formulary.
Depending on your plan's benefit design, you may have a higher co-payment.
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What is Prior Authorization?
Certain drugs have a status of Prior Authorization Required (PAR). If your
doctor wants to prescribe a PAR drug, he or she will submit a request for
approval before the drug can be dispensed as a covered benefit.
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What is Step Therapy?
Step Therapy is that 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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What are 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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What is a drug class and subclass?
Drug classes are used to group drugs that are considered similar by the disease
that they treat or by the effects that they have on the body. Subclasses
further categorize these drugs into smaller groupings.
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What is a generic drug? Is it safe to take it instead of the brand name drug?
A generic drug is a copy of the original drug that is no longer protected by a
US patent. It is typically a drug that has been available for more than 20
years. Generic drug manufacturers are allowed to produce these drugs after the
patent for the original brand has expired. Generic drugs are less expensive
than brand drugs since generic manufacturers haven't had to invest in the
research and development of the drug when it was brought to market.
Substituting a generic drug for a brand-name drug usually has no adverse
effect. Check with your doctor before switching between brand name and generic
drugs.
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How do I know if a generic drug is available?
If a generic drug is available, the 
symbol will appear next to the name. A drug may have a generic name assigned,
but may not yet be available as a generic drug. Call Customer Service if you
have any questions.
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A drug I'm interested in is listed twice. What does that mean?
The drug is in two different drug classes or subclasses. Drugs can be prescribed
for more than one disease or condition. You will need to look at the
appropriate drug class for your condition to find the status. Statuses can
differ between drug classes. For instance, a drug can be preferred in one class
and approved in another class.
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What do the dollar signs mean in the relative cost column on specific drugs?
Most drugs have a relative cost index represented by a series of one to five
dollar signs and a plus sign. This is a relative 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.
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How often is the information on this Web site updated?
The information on our general Web site is updated on a regular monthly basis.
The information on the drug formulary portion of the site is updated to reflect
the changes in formulary (typically three or four times per year).
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