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
For your convenience, EHP also offers a home delivery service through the Cleveland Clinic Home Delivery Pharmacy. To get started, please visit the Cleveland Clinic Home Delivery Pharmacy MyRefills website where you can set up your account, change your billing information and shipping address, or check on the status of your order. Please call 216.448.4200 for questions or additional information on the Cleveland Clinic Home Delivery Pharmacy.
The 2020 SPD and Prescription Drug Handbooks are currently being updated. In the interim, the charts below are the benefit summaries for the Medical and Prescription Drug benefits. For further questions please contact firstname.lastname@example.org.
Cleveland Clinic EHP Summary of Benefits and Coverage (SBC) click hereCVS/Caremark Prescription Reimbursement Claim FormTo 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. 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.
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.