Prescription Drug Information

Image of a prescription bottle and pills

We know it's important for you to have easy and affordable access to your medications. Many of PUP's plans offer Part D prescription drug coverage. You can find out if PUP covers your prescription medications by looking at our Formulary (drug list), or by speaking with a member of our Customer Service Department by calling 1-866-571-0693, TTY 711.

Can the Formulary change?

It’s important to know we may make certain changes to our formulary during the year that could affect you. Types of changes may include:

  • Adding or removing drugs from the formulary
  • Adding prior authorizations, quantity limits, and/or step-therapy restrictions on a drug
  • Moving a drug to a higher or lower cost-sharing tier

If we make any such change to our Formulary during the year, and you are taking the drug affected by the change, we will notify you of the change at least 60 days in advance. However, if a drug is recalled from the market, we will remove the drug from our Formulary immediately and notify you about the change as soon as possible.

Changes to our Formulary (both additions and deletions) are also listed on this website under Formulary Additions and Formulary Deletions.

Extra Help Premiums

Many people with limited income may qualify for extra help with the cost of prescription drugs. This extra help is provided by Medicare, and can help with costs like premiums, deductibles and coinsurance. Some people will automatically qualify.

There are three easy ways to see if you qualify:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
  • Your State Medicaid Office.

Transition Drug Policy

There are things you can do if your drug is not covered in the way you'd like it to be covered.

If your prescription drug is not on our current Formulary, or if your drug is restricted, you may be able to:

  • Get a temporary supply of the drug (only in certain situations)
  • Change to another drug
  • Request a Formulary exception
When you go to a network pharmacy and we provide a temporary supply of a drug that isn't in our Formulary , we will cover a 30-day supply (unless the prescription is written for fewer days). After we cover the temporary 30-day, we generally will not pay for these drugs as part of our transition policy again. We will provide you with a written notice after we cover your temporary supply, explaining the steps you can take the request an exception. Doing this gives you time to talk with your PCP about changing to another drug that is covered or to file a request to have the drug covered.

You are eligible for a transition drug fill if:
  • You recently enrolled with PUP and refill your drug during the first 90 days of joining PUP or during the first 93 days if you live in a long term care facility.
  • You recently were discharged from a hospital, skilled nursing facility or long term care facility.
  • Your drug will no longer be on our Formulary for the upcoming year.
  • You live in a long term care facility.
During the time when you are getting a temporary supply of a drug, you should talk with your PCP to decide what to do when your temporary supply runs out. You can either switch to a different drug covered on the Formulary or ask the PUP to make an exception for you. To find out how to request an exception, visit the Coverage Determinations & Exceptions section of our website or call Member Services.

Quality Assurance

Image of pills arranged in the shape of a heart

Making sure you’re getting safe and appropriate care is PUP’s biggest priority. We’re able to do that by providing the following additional quality assurance programs.

Drug Utilization Reviews

We perform drug utilization reviews for all PUP Members. We’ll perform these reviews on a regular basis, including each time you fill a prescription. By focusing on your specific medications, we’re able to look for problems like:

  • Duplication of drugs
  • Drug allergies
  • Dosage errors
  • Drugs inappropriate for age or gender

If we find a problem during our reviews, we’ll work with your doctor to solve it.

Medication Therapy Management

Medication Therapy Management (MTM) is designed for PUP Members with multiple medical conditions. You also might qualify for the program if you have high drug costs or take several prescription drugs.

If you qualify to be a part of a Medication Therapy Management program, PUP will contact you. We encourage Members who do qualify to participate. For more information about the MTM Program, click the link below.

PUP's Quality Assurance Programs are not considered a benefit and are provided at no additional cost to all PUP Members.