Formulary

EHP Prescription Drug Handbook and Formulary


EHP Maintenance Drug List

Updates to EHP Drug Formulary October 2018 click here

Updates: Provider Communique October 2018 click here
 


Statin Medications for Primary Prevention of Cardiovascular Disease:  As of January 1st, 2018, under the provisions of the Affordable Care Act mandate regarding cardiovascular disease preventive health services, generic formulary low to moderate dose statins will be covered under the EHP Prescription Drug Benefit at no member out-of-pocket expense within specific coverage guidelines.  To begin this process, please have the prescribing provider submit a Statin Formulary Exception Questionnaire to the Employee Health Plan Pharmacy Management Department.  All requests must meet the clinical criteria approved by the EHP Pharmacy and Therapeutics (P&T) Committee before approval is granted.  Additional information can be found in the EHP Drug Formulary Book (link above).  Download the Statin Formulary Exception Questionnaire by clicking here


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 (link above). The medications on the list may change during the year due to new drugs being approved by the FDA 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.  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.  Download the Prior Authorization/Formulary Exception Form by clicking 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. CVS/Caremark Prescription Reimbursement Claim Form click here.