FORMULARY

Welcome to the Community Health Partnership, Inc. (CHP) Formulary/Prescription Drug List.

Our formulary provides coverage information about drugs covered through our Partnership Program. You can search our formulary by either drug category or drug name.

Please note: If there is a special requirement for coverage of a drug such as prior authorization, quantity limit, or step therapy, this information will be noted in your search results.

SEARCH OUR FORMULARY HERE

Tier Description

The Partnership Program offers a variety of prescription coverage options that may have different benefits and exclusions. Please call our Customer Service Department at 1-800-546-5677 for details, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759).

Formulary Changes

The Partnership Program may add or remove drugs from the formulary during the year. Before removing drugs from the formulary or adding prior authorization, quantity limits and/or step therapy restrictions on a drug, the Partnership Program will notify providers of the change via this website at least 60 days before the date that change becomes effective. Exceptions to this would be when the US Food and Drug Administration deems a drug on the formulary to be unsafe or when the drug’s manufacturer removes the drug from the market, in which case the Partnership Program will promptly remove the drug from the formulary.

When changes are made, the 60 day notices will be listed below, by month. Additionally, affected members will be notified of the changes in their monthly statements, referred to as their Part D Explanation of Benefits (EOB).

Changes Effective October 1, 2008

General Transition Notice

A Transition Notice is a description of special consideration given to new or existing members who are currently taking prescription drugs that are not or are no longer on our current formulary.  The Partnership Program will provide a transition process on prescription drugs for a temporary time period of 30 days for all new members, members stabilized on formulary drugs that require a prior authorization or step therapy and for unplanned transitions as members change a treatment setting due to a change in the type of care they require.

Exceptions and Appeals Processes

What if I want a medicine that is not listed on the Partnership Program Formulary? Or, what if my brand name medicine is covered, but I want to ask that it be covered at a lower brand name co-pay rather than the lower cost.  These requests are called “exceptions.” You can ask for a review and a decision from us.

There may be times when you want to contact us with a complaint. If you are unable to get a prescription that you think you should get under our plan, this type of complaint is an appeal. If The Partnership Program did not pay for your prescription, or if you think that your portion of the cost was too high, this is also an appeal.

For more information on exceptions and appeals, please see Coverage Determination (Exception), Appeal and Grievance Process.

Additional details are included in the Evidence of Coverage.