Employee Health Plan – Prescription Drug Benefits

The appropriate, cost-efficient use of pharmaceutical therapies can be an effective strategy for improving your health and healthcare expenses.  Cleveland Clinic’s EHP Prescription Drug Benefit provides members with medications based on each drug’s effectiveness, safety and value.  The Prescription Drug Benefit program is administered through CVS/caremark, which offers reimbursement on prescriptions you must pay upfront.  
 

Cleveland Clinic Pharmacies Enhanced Benefit 

Cleveland Clinic EHP members have the option of paying a lower percentage co-payment for their prescriptions by using one of the following Cleveland Clinic Pharmacies
 
Additionally, you may request up to a 90-day supply of medication and have access to a pharmacy hotline for questions and pharmacist consultation services.  For your convenience, EHP also offers a home delivery service through Cleveland Clinic MyRefills

EHP Prescription Drug Handbook and Formulary click here 

Cleveland Clinic EHP Home Delivery Service Processing Form click here.

 

CVS/Caremark Prescription Reimbursement Claim Form

To be used when you must pay for a prescription up-front.  Complete the claim form for reimbursement through CVS/Caremark.

 

Prior Authorization/Formulary Exception

Prior authorization is necessary for coverage of certain medications.  These medications are listed in the Cleveland Clinic EHP Drug Formulary Book.  The medicines on the list may change throughout the year due to FDA approvals of new drugs or new indications are established for previously approved drugs.  A Prior Authorization/Formulary Exception Form must be completed or sufficient documentation must be submitted before a case will be reviewed.
 

The Cleveland Clinic/Akron General Employee Health Plan(s) prescription drug and medical benefits now require prior authorization for the following medication:  Spinraza:  first FDA-approved medication for the treatment of Spinal Muscular Atrophy (SMA).  It is administered intrathecally with 12 milligram loading doses every 14 days for 3 doses and then a fourth 12 milligram loading dose 30 days after the third dose.  Maintenance dosing is given at a dose of 12 milligrams once every four months.  Members meeting prior authorization criteria will receive coverage under the medical benefitSpinraza coverage is excluded under the prescription drug benefit.  Please contact the Employee Health Plan Pharmacy Management Department at 216.986.1050, option 4, with any questions or to request prior authorization.

Disclaimer:  All requests must meet the clinical criteria approved by the Pharmacy and Therapeutics (P&T) Committee before approval is granted. In some cases, approvals will be given a limited authorization date. If a limited authorization is given both the member and the physician will receive documentation on when this authorization will expire. Most requests will be processed within 1-2 business days from the time of receipt. A response will be faxed to the requesting physician, and the member will be informed of the request and the decision via mail.