Welcome to Physicians Health Plan's Pharmacy Network page! Whether you are looking to fill a prescription, ask questions about your medications, or simply view the drug formulary that applies to your benefit plan, you can access it all here.

To visit Express Choices^SM, the customized Express Scripts Pharmacy Web site, click here.

• Pharmacy Provider Search
• Understanding your Rx Benefits
• Brand vs. Generic
• The Importance of Communication
• Pharmacy Ethics

Pharmacy Network

Our members have access to over 40,000 pharmacies across the nation, including all Walgreens, CVS, and Scott's Pharmacy locations. To find a pharmacy provider located in Indiana, Ohio or Michigan, click here or call our Customer Service Department at (260) 432-6690, extension 11 or toll free (800) 982-6257.

Understanding your Rx Benefits

PHP wants you to get the most out of your healthcare insurance coverage. If you understand your pharmacy benefit and how it works, you can use it to save money on the cost of your prescriptions and maximize your benefit.

The following information will aid you in understanding your pharmacy benefits. Should you have further questions, please check your Summary of Benefits, or call a PHP Customer Service Representative for a description of your coverage.

Which pharmacy program do I have?

As a member, you have one of several possible pharmacy prescription programs: a two-tiered program, a three-tiered program, or a High Deductible Health Plan program with an HSA or HRA. Please refer to your Summary of Benefits, Certificate of Coverage, or Member ID Card to determine which program applies to you and your family. For detailed information, select the option that matches your coverage below.

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What is the difference between a brand name and generic drug?

Brand Name Drug - Patented drug that has been approved by the FDA to treat a given medical condition.

Generic Drug - A drug that is no longer protected by a patent.

Should a generic drug be substituted? Is the medication prescribed formulary or non-formulary? Please verify with your participating doctor or PHP.

What if a brand name prescription is prescribed and only the generic is covered? If a generic medication is required instead of a brand name medication, the pharmacy will only dispense the generic medication if signed "may substitute" by the PHP doctor on the prescription. If a brand name medication is prescribed and the prescription is signed "dispense as written" the pharmacist cannot legally change the doctor's orders and you will be charged your prescription co-pay, plus the cost difference between the generic and brand name medication.

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.

Specialty Drug - 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.

Is a mail order program available?

Yes, Express Scripts Mail Order Program at (800) 557-3952.

Make sure you can answer "yes" to the following questions:

• Have you included the personal information sheet and original prescription form? (First time submissions only)
• Have you allowed at least two weeks for Express Scripts to fill your prescription?
• Was your prescription written by a PHP doctor?
• Does the prescription have the correct quantity of pills for a 90-day supply of medication?
• Has the doctor signed the prescription on the right-hand line to allow for generic substitution when required?
• Have you supplied accurate payment information?

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Brand vs. Generic

Most prescription drugs have two names. One is the brand name that is used for advertising and marketing; the other is the generic name, which usually identifies the chemical ingredients of that medication.

Although a prescription drug may have a generic name, that does not necessarily mean that a generic drug is available. New drugs are patent-protected for twenty years after they are discovered. During this time, no generic may be sold for the drug. After the patent expires, however, the FDA allows other companies to manufacture equivalent versions of the drug, which are then sold at a discounted price (sometimes 30% or even 50% less than the original brand name drug).

In order for the generic drug to pass FDA standards, it must supply the same amount of active ingredient absorbed at the same rate as the original drug. It must also be of the same strength, have the same effect, and be of the same dosage form.

There can be a few minor differences between a generic and a brand name drug. These include colorings, fillers, and flavors. These are the aspects that could cause a subtle difference in how the patient experiences the drug.

Although the difference is usually slight, it is important to ask your doctor the difference between the brand name and generic for what he/she intends to prescribe. However, you can rest assured that the FDA requires generic drugs to perform in the same way as their brand name counterparts, and all pharmaceuticals available in the United States undergo very strict review.

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The Importance of Communication

Effective communication is the process of sending and receiving information in a manner that is both concise and comprehensive to all parties involved. This process is essential in a patient/physician relationship. In order for a physician to correctly diagnose and treat a patient, he/she must fully comprehend the patient's symptoms. In the same manner, in order for the patient to benefit from treatment methods, he/she must comprehend the method, why it is used, and how to properly use it.

Patients and Physicians must both speak and listen. Here are some tips on how to do your part:

1. Give your doctor the whole story. When it comes to prescriptions some important information includes: (1) your medical and prescription history, (2) any current or anticipated lifestyle changes, (3) any past allergic reactions or side effects experienced with medications, and (4) any supplements or dietary/herbal products that you are currently using. It is important to note that many dietary or herbal products are not federally regulated and that little information is known about many of these. Due to this fact, the safety of these items is often unknown, making it even more crucial for your physician to be made aware if you are taking them.
2. Often the goal of effective communication cannot be reached without questions. Patients should feel free to ask their doctor about anything, regardless of any hesitation - they've heard it all before. When it comes to your prescription, some very important questions to ask are: (1) What medicine are you prescribing and what is it for? (2) How do I take it and when do I stop? (3) What side effects are common for people taking this? (4) Is there anything I should avoid while on this medication (food, drink, activities)? and (5) Do you have any written information on this drug? Also, if you have questions on an over-the-counter medication (OTC) or any herbal/supplemental products, be sure to ask your doctor about them. It is possible that they may have written information on these items as well.

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Pharmacy Ethics

The Merriam-Webster Dictionary describes ethics as moral principles or practices. Often, pharmacists must deal with ethical issues in their work environment. These issues must be resolved by weighing the benefits of the possible outcomes. And always, a pharmacist must act according to the oath taken upon the completion of their pharmacy licensing. This oath establishes the commitment that a pharmacist must display to the welfare of humanity, service of mankind, and the high principles of moral, legal, responsible, and ethical conduct.

Oath of a pharmacist
American Association of Colleges of Pharmacy

At this time, I vow to devote my professional life to the services of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will maintain the highest principles of moral, ethical and legal conduct.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

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