Prescription Drug Information

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We understand it’s important for you to have easy and affordable access to your prescription drugs. Many of PUP's plans offer Part D prescription drug coverage. You can see if PUP covers your prescription drugs by looking at our Formulary (drug list) or you can search by typing in the name of the drug.

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 Policy

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

As a new Member, the following situation(s) may apply to you:

  • If you are taking a non-formulary drug and need a refill for the drug during the first 90 days of membership, we may provide a temporary supply.
  • If you are a new Member and a resident of a long-term care facility (like a nursing home), we will cover a temporary 31-day transition supply (unless the prescription is written for fewer days.)
  • If you are a new Member that has been enrolled in our plan for more than 90 days and need a drug that isn’t on our formulary or is subject to other restrictions, such as step therapy or dosage limits, we will cover a temporary 31-day emergency supply (unless the prescription is for fewer days) of the drug while you pursue a formulary exception.

Please note that our transition policy applies only to “Part D drugs” bought at a network pharmacy.

You can contact Members Services if:

  • Your drug is not on our formulary
  • Your drug is subject to certain restrictions
  • Your drug will no longer be on our formulary for the upcoming year
  • You need help switching to a different drug that we do cover
  • You would like to request a formulary exception

Quality Assurance

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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.