AtlantiCare Benefits Book 2020

Prescription Drug FAQs

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOUNTS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56

Prescription Drug FAQs What happens if my provider indicates “do not substitute” on the prescription? If this is the first time you’d be receiving this brand name medication, your prescription must go through a prior authorization process. If approved, the prescription will be filled for the brand name, and you will be charged the copay based on whether it is formulary or non-formulary. What is the Maintenance Medication Program? This program allows you to get your initial prescription filled at a retail pharmacy. You can then get the first refill at that same retail pharmacy, however, once you have exhausted these fills, you must begin utilizing the AtlantiCare Pharmacy (retail or mail order).

How do I know if my drug is formulary or non-formulary? You can call Geisinger pharmacy customer service or go to their website at https://www.thehealthplan.com/atlanticare to look up your medication. The prescription drug list is also located on the HR Portal: Benefits tab and Pharmacy portals for your information. Under what circumstances would I receive a 15-day supply of my medication? You may receive only a 15-day supply of a specialty medication if it is newly prescribed to you. These medications are highly specialized and may not work appropriately for you. You may be given a 15-day trial to make sure it is working. If the drug does not work as intended, this will save you the extra cost of a full 30-day prescription and reduce waste for AtlantiCare.

Why should I use the AtlantiCare Pharmacy? Your prescriptions may be less expensive when using the AtlantiCare Pharmacy.

46