We provide general product support and education, as well as supplemental injection training, and injection and refill reminder calls.Įvery day is different depending on the type of calls that we have. When our patients call in, they get to speak to a real person, a experienced clinician who can provide them support along their journey. So, we step into our offices, we’re going into a nice relaxing environment. I’m ready to help our patients to have the confidence to proceed with their journey. I chose to be a nurse because I wanted to help people, and I believe that people should be in service to others.īeing a nurse for DUPIXENT MyWay is very rewarding. My name is Shari and I’m a registered nurse with DUPIXENT MyWay. The small-town environment lends to the type of work that I do, more one-on-one with our patients. Copays are $100 for preferred drugs and $200 for non-preferred drugs.I grew up in a very small town-one stop light, if you blink you might miss it. You must pay a copay for each 30-day fill of a specialty drug. Specialty drugs are usually high-cost drugs that require special handling and extensive monitoring. New drug categories also can become subject to quantity limits throughout the year. When new drugs become available in drug categories that have quantity limits, they will automatically have quantity limits per copay. If generics are available or become available for brand-name drugs that are limited in quantity, the generics are also limited in quantity. Some step therapy drugs may also be limited in quantity. If you require a step therapy exception, contact CVS Caremark Pharmacy Prior Authorization Department at 80 or TTY 711.īrand-name exception and non-preferred drugs reviewĪ prior authorization for a brand-name or non-preferred drug may be approved when you are unable to tolerate the generic or preferred drug. All of these reviews follow the same process as described in the Pharmacy prior authorization section above.Ĭertain drugs are limited in the quantity you can receive per copay based on their recommended duration of therapy and/or routine use. Step Therapy prior authorizations require you to first try a designated Preferred drug to treat your medical condition before the plan covers another drug for that same condition. Traditional prior authorization reviews typically require that specific medical criteria be met before access to the drug is allowed. If your prior authorization is denied, your physician’s office is notified of the denial within 24 to 48 hours.If your prior authorization is approved, your physician’s office is notified of the approval within 24 to 48 hours.The pharmacy benefit manager will assist your physician’s office with completing a prior authorization form.Have your physician’s office call the pharmacy benefit manager toll-free at 80.Are generally used for cosmetic purposes.įollow the steps below to request a prior authorization:.Pharmacy prior authorization is a medical review that is required for coverage of certain drugs such as those that: Pharmacy prior authorizations, quantity limits, specialty drugs and step therapy for HealthChoice High, High Alternative, Basic and Basic Alternative Plans and High Deductible Health Plan (HDHP). Copays apply to the pharmacy out-of-pocket maximum, but not the deductible.įor questions regarding the benefits under the pharmacy plan, please contact the pharmacy benefit manager toll-free at 87, 24 hours seven days a week. Medications on the HealthChoice Preventive Medication List are not subject to the deductible. **HDHP members must meet the combined medical and pharmacy deductible ($1,750 individual/$3,500 family) before benefits are available. *HealthChoice High, High Alternative, Basic and Basic Alternative plan members must meet the pharmacy deductible of $100 per individual/$300 maximum per family before benefits are available. Experimental treatments and unapproved drugs and drugs not approved or not authorized for emergency use by the FDA are not covered under this plan. Note: Only FDA approved drugs and drugs with FDA Emergency Use Authorizations are covered. Refer to the bottom of the page for more details. ![]() HealthChoice High*, High Alternative*, Basic*, Basic Alternative* and HDHP** Plans The applicable pharmacy deductible must be met before pharmacy copays apply. 30-day copays apply to each additional 30-day supply.Įffective Nov.
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