HealthChoice Medicare Supplement Plans
Your physician may prescribe a medication that is not listed in the HealthChoice Medicare Formulary. That medication is called a non-formulary drug. If you receive a prescription for a non-formulary drug, your options are to:
- Ask your physician for a prescription for a generic (Tier 1) or a Preferred (Tier 2) medication that is listed in the HealthChoice Medicare Formulary.
- Continue with the non-formulary medication and pay the full cost.
- Ask your physician to request a prior authorization for coverage of a non-formulary medication.
A request for prior authorization must be submitted by your physician and the request must be approved before you fill your prescription. To apply:
- Have your physician’s office contact Express Scripts toll-free at 1-800-935-6103.
- Express Scripts will fax a Prior Authorization Form to your physician’s office and request that it be completed and faxed back.
- If your prior authorization is approved, your physician’s office is notified of the approval within 24 to 48 hours. You are also notified in writing.
If a prior authorization is approved, the medication is covered as a non-Preferred drug and you pay the higher copay unless you also request a prior authorization for a Preferred copay.
Generally, a prior authorization is valid for one year from the date it is issued and must be renewed when it expires.
For more information, contact HealthChoice Member Services and ask for the Pharmacy Resolution Unit.
- All Members call 1-405-717-8780 or toll-free 1-800-752-9475
- All Members TDD 1-405-949-2281 or toll-free 1-866-447-0436 or Fax 1-405-717-8942.
Note: Not all prescriptions are covered. The law does not allow Medicare to cover certain types of drugs, and HealthChoice decided not to cover certain drugs.