 |
       |
Formulary and Formulary InformationView the 2008 CCM Direct Formulary. The CCM Direct formulary was developed by highly qualified physicians and pharmacists. If you are taking a drug that is not in our formulary, we have effective alternatives that can also help you save money on prescriptions. To learn more about these alternatives or if you cannot find your prescription in our formulary, please call Medco Customer Service at 1-800-935-7195. TTY/TDD users should call 1-800-716-3231. Customer Service is available to assist you 24 hours a day, 7 days a week. CCM Direct covers both brand-name and generic drugs. Please review the information below concerning these drugs. Generic: Generic drugs have the same active ingredient as a brand name drug. Generic drugs typically cost less than brand name drugs and are approved by the Food and Drug Administration (FDA). Preferred brand drugs: Among brand drugs, these are the ones that CCM Direct prefers. Non-preferred brand drugs: Drugs in this category are not on CCM Direct’s preferred list. You can continue to use these drugs, but you may pay more. Non-covered drugs: These drugs are not covered by CCM Direct. Out-of-network pharmacy coverage CCM Direct members must use a network pharmacy to receive plan benefits. CCM Direct has established a reliable and convenient network of 2,116 pharmacies in our service area. If you use an out-of-network pharmacy, CCM Direct may not pay for your prescriptions, except in certain cases. Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling outside of the CCM Direct service area where there is no network pharmacy. In this situation you will have to pay the full cost rather than just your co-payment when you fill your prescription. Additionally, you may be required to pay the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions. You can request CCM Direct to reimburse you for our share of the cost by submitting a paper claim. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
Additional, important information about CCM Direct’s prescription drug plan can be found below. Drug Utilization Review CCM Direct requires participating pharmacies to perform drug utilization review (DUR) each time you fill a prescription. This is designed to analyze drug safety and usage for members based on their profile. The DUR is an important tool that screens for potential drug complications such as:
The drug utilization review serves as a measure to ensure that drug usage criteria are met and satisfy FDA guidelines. Clinical protocols are adopted by our plan’s Pharmacy and Therapeutic Committee and First Data Bank Criteria. Based on this review, the attending pharmacist and/or physician can make the most beneficial decision regarding the pharmaceutical care for the patient. Quality Assurance CCM Direct ensures the safety and health of its members through the establishment of effective Quality Assurance measures and systems. We do this to reduce medication errors and adverse drug reactions, and improve medication utilization. These measures include making sure that providers comply with pharmacy practice standards, drug utilization review, internal medication error identification systems, medical therapy management programs, and pharmacy and therapeutics committees. CCM Direct also partners with state Quality Improvement Organizations (QIO), that are contracted with Medicare to collect, analyze, and report data based on medication therapy practices. Tier Cost Sharing Tier cost sharing is a term that means there is cost sharing for drugs that are classified under specified tier levels. Each level has co-payment amounts that the member is responsible to pay. The CCM Direct formulary has five tiers, preferred generic, non-preferred generic, preferred brand, non-preferred brand, and specialty. Medication Therapy Management CCM Direct’s Part D plan offers a medication management program at no additional cost for members who have multiple medical conditions, who are taking many prescription drugs, or who have high drug costs. This programs was developed for us by a team of pharmacists and doctors. We use the medication therapy management program to help us make sure that our members are using appropriate drugs to treat their medical conditions and help us identify possible medication errors. Additional information is available from Medco Customer Service department at 1-800-935-7195 (TTYTDD users should call 1-800-716-3231) 24 hours a day, 7 days a week. If you have any questions about coverage determinations, exception requests, appeals or grievances, please contact Medco Customer Service at 1-800-935-7195; TTY/TDD uses should call 1-800-716-3231. Customer Service is available 24 hours a day, 7 days a week. Formulary Updates CCM Direct will provide 60 days notice on this web-site prior to removing a Part D drug from the Formulary or making changes in the preferred or tiered cost sharing status of a covered Part D drug. Please note that the Formulary may change during the year. Click here to view the Notice of Formulary Changes. |
|
|
We welcome your inquiries - call us toll free at 1 (877) CCM-8500 or email us H5989_CompFormulary_5003_110706. CCM is a member of The Beth Abraham Family of Health Services. This page last modified on May 1, 2007. |