Preferred Drug List
Notice of Formulary Changes:
Formulary Prior Authorization Approval Criteria
Certain drugs need authorization from Elderplan prior to dispensing at the pharmacy. Please click on the Prior Authorization Approval List link to see if you meet the criteria for you to receive authorization for your drug. You can also go to the Searchable Formulary – coming soon, to see if your drug needs prior authorization. If you have any questions regarding prior authorizations, call our pharmacy benefit manager at 1-800-361-4542 or Customer Service at 1-800-353-3765, or the TTY number for the hearing impaired , 1-800-662-1220, seven days a week between the hours of 8:00 a.m. and 8:00 p.m
Prior Authorization Approval Criteria List
Step Therapy
Step Therapy is a key part of our prior authorization program that allows us to help your doctor provide you with an appropriate and affordable drug treatment. Before coverage allowed, Elderplan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Elderplan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Elderplan will then cover B. Please click on the Step Therapy Approval List – to see if your drug requires Step Therapy. You can also go to the Searchable Formulary to see if your drug requires step therapy. If you have any questions regarding Step Therapy, call our pharmacy benefit manager at 1-800-361-4542 or Member Services at 1-800-353-3765. The TTY number for the hearing impaired is 1-800-662-1220. Member Services is available seven days a week between the hours of 8:00am and 8:00 pm.
Quantity Limit
For certain drugs, Elderplan limits the amount of the drug that Elderplan will cover. For example, Elderplan provides 5 tablets per prescription for Anzemet. This may be in addition to a standard one-month or three-month supply. Please click on the Quantity Limit Approval List – to see if your drug has Quantity Limit restriction. You can also go to the Searchable Formulary to see if your drug has quantity limit restriction. If you have any questions regarding Quantity Limit, call our pharmacy benefit manager at 1-800-361-4542 or Member Services at 1-800-353-3765. The TTY number for the hearing impaired is 1-800-662-1220. Member Services is available seven days a week between the hours of 8:00 a.m. and 8:00 p.m.
