Drug Formulary
The formulary is created by a team of practicing doctors and pharmacists who carefully evaluate the available scientific evidence. For some prescription drugs, the team has recommended additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs safely and effectively.
Drug Utilization Reviews
Drug Utilization Reviews help prevent medication problems such as over-medication or drug interactions, When you fill a prescription at the pharmacy, the pharmacist submits the prescription to us electronically for payment.
Our computer system automatically compares this prescription to other prescriptions you have filled, including prescriptions at other pharmacies. If it detects a potential problem, it alerts the pharmacist so he or she can discuss the issue with you and/or your doctor.
Potential problems include (but are not limited to):
- Possible medication errors in dose or quantity
- Duplicate drugs that may be unnecessary because you are taking another drug to treat the same medical condition
- Drugs that may not be safe or appropriate because of your age, gender or disease
- Certain combinations of drugs that could harm you if taken at the same time
- Prescriptions written for drugs that have ingredients you are allergic to
Medication Therapy Management (MTM) Program
This program is especially helpful for members who take several medications for chronic medical conditions, such as hypertension, hyperlipidemia, diabetes, and asthma.
- A FamilyCare pharmacist may contact you to talk about all of the medications you are taking, including over-the-counter medications or natural supplements. They will make sure you understand what they are for and how to take them safely. The pharmacist will also work with your providers to make sure you are taking the safest and most effective medications.
- There is no cost for this program and if you qualify for this program we will contact you. We hope you will participate so that we can make sure that you are using the drugs that work best to treat your medical conditions and help us identify possible medication errors.
- If you have questions about the Medicare Medication Therapy Management Program, please call Customer Service at (866) 798-CARE (2273), TTY/TDD users should call (800) 735-2900. We are available Monday to Friday from 8 am - 8 pm.
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