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2018 formularies
DRUGS WITH RESTRICTIONS AND CRITERIA

2018 ABRIDGED FORMULARY
2018 COMPREHENSIVE FORMULARY -
EFFECTIVE NOVEMBER 1, 2018
2018 ADDITIONAL INFORMATION
2018 MEDICATION THERAPY MANAGEMENT (MTM)

Prescription Drug Information (Part D)

PrimeTime Health Plan covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

The Formulary is subject to change during the year. Most of the changes in drug coverage happen at the beginning of each year (January 1); however, the plan may make changes during the year, with CMS approval. In cases of any changes to our formulary including addition of a prior authorization, adding quantity limits, step therapy, making a drug non-formulary and changing cost share due to a tier level change of formulary drugs, PrimeTime Health Plan will send a letter to the members that have been affected by the change.

If one of your drugs is not covered in the way you would like it to be covered, you have the right to ask for a “coverage determination”. A coverage determination is when we make a decision about whether a drug is covered by the plan and the amount, if any, you are required to pay for the prescription.

When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. We will then consider your request. (You cannot ask for coverage of any “excluded drugs” or other non-Part D drugs which Medicare does not cover).

You, your representative, or your doctor (or other prescriber) can request a coverage determination by calling, emailing, writing, or faxing our plan at the numbers below. In addition, you may contact us for the most recent list of covered drugs or visit www.primetimehealthplan.com.

Telephone: 330-363-7407 or toll-free 1-800-577-5084 (TTY/TDD Line: 330-363-7460 or toll-free 1-800-617-7446) Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)

Email: PTHPPharmacy@aultcare.com 

Fax: 330-580-6764 

Mail: P.O. Box 6905, Canton, Ohio 44706 

For more detailed information, please refer to the “Coverage Determination” link on the Additional Information Page or your Plan's Evidence of Coverage.

Last updated:09/25/2018