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Preferred Drug List (PDL) OREGON HEALTH PLAN Trilliumohp.Com Preferred Drug List (PDL) OREGON HEALTH PLAN TrilliumOHP.com 1-877-600-5472 TTY: 711 MCA_EK16V5 Approved 01/01/2019 OHP-TRIL-17-195 Pharmacy Program Trillium Community Health Plan’s goal is to offer the right drug coverage to our members. We work with doctors and pharmacists to make sure we offer drugs used to treat many conditions and illnesses. Trillium covers prescription and some over the counter drugs when they are ordered by a licensed prescriber. The pharmacy program does not cover all drugs. Some drugs need our prior approval. Some have a limit on the amount of drug that can be given. Sometimes you must get Trillium’s prior approval. Even with approval, we will not pay if you are no longer on OHP or if the treatment isn’t covered by OHP. To be paid, the treatment must follow treatment guidelines. This might include step therapy, meaning trying less costly treatment options first. Medications newly approved by the FDA (Food and Drug Administration) require prior- approval until reviewed by our Pharmacy and Therapeutics Committee. Filling a Prescription You can have your prescriptions filled at a Trillium network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your ID card. You can find a pharmacy that is in network by calling a Trillium Member Services Representative at 541-485-2155; Toll Free: 1-877-600-5472, or by using the Find a Provider tool on our website at https://providersearch.trilliumhealthplan.com. You do not have to pay for covered drugs. The Trillium preferred drug list has a large number of brand name and generic drugs on it. Trillium asks that doctors prescribe medication from the Trillium preferred drug list for their patients who are members of Trillium. Some drugs will need your doctor to submit a prior approval request before the medication can be given to you at the pharmacy. These drugs are on the prior approval list. All prior approval reviews are done by a licensed clinical pharmacist using the Trillium Pharmacy and Therapeutics Committee’s guidelines. Trillium will cover the drug if it is decided that: 1. There is a medical reason that you need the specific drug. 2. Other drugs on the preferred drug list have not worked for you. Once approved, your doctor will be contacted. If the information given does not meet requirements for the requested drug, we will contact you and your doctor, and tell you about the appeal process. Generic Drugs Generic drugs work the same as brand name drugs. When there is a generic drug available, your doctor will need to ask for a prior approval for the brand name drug. We will review the prior authorization and cover the brand name drug if there is a medical reason you need the brand name drug. Specialty Drugs Retail pharmacies do not have specialty drugs. You can get these drugs from our specialty pharmacy, AcariaHealth. Your doctor may need to ask for a prior approval for you to receive a specialty drug. Over-the-Counter Medications Trillium will pay for over the counter drugs that are on the preferred drug list. To be covered, your doctor will need to write you a prescription for the drug. 72-Hour Emergency Supply Policy If you have an urgent need for a drug, your doctor can ask Trillium for an urgent preapproval. Trillium will look at these requests within 24 hours. If we cannot look at the request in time, Trillium will let the pharmacy give you the drug for three days. Step Therapy Some drugs listed on the Trillium preferred drug list may need you to try other drugs before you can receive the step therapy drug. If Trillium has a record that you have tried this drug, the step therapy drug is covered. If Trillium does not have a record that you have tried this drug, your doctor may need to submit a prior approval. Dispensing Limits, Quantity Limits, and Age Limits Trillium may limit how much of a drug you can get at one time. You may get up to a 30 day supply for each new or refill of a non-controlled drug. Most prescriptions can be refilled after 24 days. Some drugs on the Trillium preferred drug list may have an age limit, which is set by the Food and Drug Administration (FDA). If your doctor feels that you have a medical reason for getting a larger amount of the drug, or that you should receive a drug even if you do not meet the age limit, they can ask for a prior approval. Appropriate Use and Safety Edits Your health and safety are important to Trillium. One way we keep you safe is through Point-of-Sale (POS) changes at the time a prescription is processed at the pharmacy. These changes are based on FDA recommendations and promote safe and effective medication use. Pharmacy Benefit Exclusions These medications are not covered by Trillium: Medications that do not have an FDA-approved use; Medications that are not medically necessary; Experimental or investigation medications; Medication products for a diagnosis that is not covered by the Oregon Health Plan; Medications that are an excluded service under the Oregon Health Plan; Medications to treat mental illness (therapeutic classes 7 and 11); Medications to help you get pregnant; Home pregnancy kits; Cosmetic or hair-growth medications; and Medicare Part D covered drugs for dual members. Mail Order Program If you are taking a drug to treat a long-term medical condition or illness, you may be able to get a 60-day supply of your drug by mail. Please contact a Trillium Member Service Representative if you have any questions. Do you think Trillium Community Health Plan (TCHP) has treated you unfairly? Trillium must follow state and federal civil rights laws. It cannot treat people unfairly in any of its programs or activities because of a person’s: Age Gender identity Race Sexual orientation Color Marital status Religion Disability National Origin Sex Everyone has a right to enter, exit and use buildings and services. They also have the right to get information in a way they understand. Trillium will make reasonable changes to policies, practices, and procedures by talking with you about your needs. To report concerns or to get more information, please contact Member Services at 541- 485-2155; Toll Free: 1-877-600-5472; TTY: 1-877-600-5473, Monday through Friday, 8:00 a.m. to 5:00 p.m. At other times – including Saturday, Sunday, and federal holidays – you can leave a voicemail. We will return your call the following business day. The call is free. You also have a right to file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Contact that office one of these ways: Web: www.hhs.gov Email: [email protected] Phone: 1-800-368-1019, 1-800-537-7697 (TDD) Mail: 200 Independence Ave., SW, Room 509F HHH Bldg. Washington, D.C. 20201 English ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-877-600-5472; TTY: 1-877-600-5473. Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-600-5472; TTY: 1-877-600-5473. Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, c các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-600-5472; TTY: 1-877-600-5473. 繁體中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1- 877-600-5472; TTY: 1-877-600-5473. Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-600-5472; TTY: 1-877-600-5473. 한국어 (Korean) 주의: 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 . 1-877- 600-5472; TTY: 1-877-600-5473. Українська (Ukrainian) УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером. 1-877-600-5472; TTY: 1-877-600-5473. 日本語 (Japanese) 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1- 877-600- 5472; TTY: 1-877-600-5473. まで、電話にてご連絡ください Arabic: تنبيه: إذا كنت تتحدث اللغة العربية فإن خدمات المساعدة اللغوية متاحة لك مجاناً . اتصل بـ على رقم 5472-600-877-1، رقم هاتف الصم والبكم: 1-877-600-5473. Română (Romanian) ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-877-600-5472; TTY: 1-877-600-5473. ߒមែរ (Cambodian) ប្រយ័㿒ន៖ បរើសិនᾶ诒នកនិ架យ 徶羶ខ្មែរ, បស玶ជំនួយខ្ននក徶羶 បោយមិនគិ㿒⏒ន ួល គឺ讶ច掶នសំ殶រ់រំបរ诒ើ នក។ ច ូរ ទូរស័寒ទ 1-877-600-5472; TTY: 1-877-600-5473. Cushite XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-877-600-5472; TTY: 1-877-600-5473. Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-600-5472; TTY: 1-877-600-5473. (Farsi) ف ار سی توجه : اگر به زبان فارسی گفتگو می کنيد، تسهي ﻻت زبانی بصورت رايگان برای شما تماس بگيريد. فراهم می باشد. با.TTY: 1-877-600-5473 ;1-877-600-5472 Français (French) ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-600-5472; TTY: 1-877-600-5473 ภาษาไทย (Thai) เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร. 1-877-600-5472; TTY: 1-877-600- 5473. Tier Definition: F Preferred Drugs NF Non-formulary CO Carve Out Drugs Legend Description AL Age Limit Drug is limited to specific age. Prior PA Prior Authorization required before prescription can be filled.
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