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Q: What is a Drug Formulary? (List of covered drugs) A: A drug formulary is a list of safe drugs used to treat sick people and improve health. The Health Plan of Michigan (HPM) Formulary uses the clinical advice of doctors, pharmacists and other medical experts to come up with this drug list. Click Here for the 2010 HPM Medicaid Formulary Q: What is a Pharmacy Benefits Manager (PBM)? A: A PBM is a company that works for HPM to set up places to fill prescriptions for our members. CVS/Caremark is our PBM. CVS/Caremark also takes care of drug prior authorization (PA) requests for HPM. Q: What is a Prior Authorization (PA)? A: The HPM Formulary is a detailed list of drugs. There may be times when your doctor writes a drug for you that is not on the covered drug list. Your doctor can fill out a PA request form, giving facts about your medical history and the need for the drug. Note: We must first approve the drug given before you can have the drug filled. Q: What happens if the Prior Authorization (PA) is not approved? A: HPM and our Formulary Team have reasons based on medical facts for approving or denying drug requests. A denial can happen if HPM covers a drug(s) that can treat the same condition you may have, but that drug has not been tried yet. You and your doctor will get an answer back in writing, with the reason(s) why a drug request has been denied. The letter will also give an appeal process if you and your doctor disagree with the denial. Q: What is a quantity limit (QL)? A: For some drugs, there are limits to how many tablets or how much liquid you can take in a day. This is based on the drug maker's research and licensing by the FDA. That number is set for the total number of tablets or liquid that you may fill with a prescription each month. If your doctor feels that you need more of a medication, he/she must fill out a PA request. Q: What is the Phone Number to CVS/Caremark? A: The number to CVS/Caremark is 1-888-883-0698. Q: What is Step Therapy? A: HPM will ask members to try first line drugs to treat your medical issue before we will cover another drug for the same reason. If you have already used the drugs we suggested and they did not work, please ask your doctor to fill out a PA request form. Your doctor should list when the drug was used and why the drug did not work.
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