HometownRx Formulary – January 2022
This formulary is intended to assist you to better understand your pharmacy coverage .
Knowing your pharmacy benefit and effective use of the formulary ( drug list ) will help you be engaged in your treatment options and health . This document will help you get the answers to these questions :
� What medications are covered ?
� What are my lower cost medication options ?
� How is this formulary developed to ensure I have the best products ?
� What can I do if the medication I need is not covered ?
� Why do I need to obtain an approval ( prior authorization ) to get what my provider ordered ?
What is a Formulary ?
The formulary is a list of preferred brand and generic drug products for HometownRx members . The drug list includes drugs used to treat common diseases or health problems . A team of doctors and pharmacists ( Pharmacy and Therapeutics ( P & T ) Committee ) meet to decide which drugs should be on the drug list . The P & T Committee reviews new and existing drugs and chooses drugs that work best and are proven to be safe . Consequently , the formulary is updated regularly and subject to change without notice . The formulary is a good source for you and your provider to determine the best drug for your condition , at the lowest out-of-pocket expense to you . Ultimately , specific drug product selection for an individual member is dependent on your prescriber .
How to Search For Drugs
The formulary that begins on page 1 provides coverage information about the drugs covered by HometownRx . If you have trouble finding your drug in the list , please turn to the Index at the end of the formulary . The first column of the chart lists the drug name . Brand name drugs are capitalized ( e . g ., HUMIRA ) and generic drugs are listed in lower-case italics ( e . g ., adalimumab ). The information in the Requirements / Limits column tells you if HometownRx has any special requirements for coverage of your drug .
Benefit Coverage and Limitations
Certain drug products have been excluded from this formulary . If you choose to use an excluded drug product HometownRx may not reimburse for these drug products and may require you to pay 100 % of the cost . Furthermore , if you choose to use a drug that is not on formulary or excluded , the cost , does not accumulate towards meeting your annual deductible or out-of-pocket maximums .
Certain classes of medication are not covered under your pharmacy benefit . These medication classes may include but are not limited to : non-FDA approved drugs , over the counter ( OTC ) medications , drugs to treat impotency or sexual disorders , fertility agents , weight loss drugs , hematinics , reusable needles , disposable syringes , ostomy supplies , infant formulas , dietary supplements , hypopigmentation agents , diagnostic agents , cosmetic medications , and compounded medications .
An ancillary charge ( as know as a Brand Penalty [ BP ]) may apply to brand medications when an equivalent generic is available . If a member or provider chooses a brand medication over the generic medication , the