Prescription Drug Information

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We know it’s important for you to have easy and affordable access to your medications. You can see if PUP covers your prescription medications by doing a Formulary Search, or by looking at the 2010 Formulary for a complete listing of covered drugs.

Generally, PUP covers any drug listed in our formulary as long as:

  • The drug is medically necessary
  • The prescription is filled at a network pharmacy
  • All other plan rules are followed

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.

Transition Policy

You may be affected by changes in our drug formulary from one year to the next.

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

In most cases, Your PCP will help determine the right course of action.

If you are a current Member affected by a formulary change from one year to the next, we will provide a temporary supply of the non-formulary drug, if you need a refill, during the first 90 days of the new plan year.

When you got 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 to request an exception.

Please 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. That’s why we have included 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.

If you are experiencing any problems or discomfort with your prescription drugs, let your PCP know immediately.

Medication Therapy Management

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

If you qualify to be a part of a Medicare Therapy Management program, PUP will contact you. If you are selected, we strongly encourage you to take advantage of the program. For more information about the MTM Program, click the link below.

If you have any questions, please call Member Services, Monday – Sunday 8:00 a.m. to 8:00 p.m., at the number listed below:

  • Toll-Free: 1-866-571-0693
  • TTY/TDD: 1-800-955-8771

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