THP Rx Formulary
THP Rx offers various plans that cover generic, brand name and non-formulary options. Our formulary is developed with clinical supportive material to meet the members needs in a clinical and cost-effective manner.
The Health Plan formulary helps manage drug cost while keeping our membership's health and safety our main goal. We collaborate with other healthcare professionals to design a list of drugs known as a formulary. A formulary is a listing of generic and brand name prescription medications that are preferred for use by The Health Plan. THP Rx maintains formularies with certain restrictions across several therapeutic classes. In these classes, the preferred drugs will be a covered benefit when dispensed at participating pharmacies.
MEMBERS: Register or login to myplan.healthplan.org to access your pharmacy benefits or to use the "Find a Drug" tool.
We may add or remove drugs from our formulary during the year. To inquire about the status of a drug on the formulary, please contact our Pharmacy Service Department at 1.800.624.6961, ext. 7914, 24 hours a day, 7 days a week. Members are notified 60 days before the date of change if drugs are removed from the formulary; add prior authorization; quantity limits and/or step therapy restrictions; or moved to a higher cost-sharing tier. If the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
Prescriptions for drugs presented to the pharmacy that are not covered due to non-formulary status must be converted to a formulary drug, or the non-formulary drug must be pre-authorized by THP Rx for a medically-appropriate reason. The pharmacist should attempt to contact the prescribing physician and suggest the formulary drug for treatment. If conversion to the formulary drug is authorized, the pharmacist will fill the prescription in the usual fashion and provide the member with appropriate information on proper use of the medication. Should the prescribing physician decide that the original (non-formulary) drug is medically necessary, the physician or member may contact THP Rx to initiate an exceptions request by phone at 1.800.624.6961, ext. 7914, email email@example.com, or submit an Exceptions Request form.
Authorizations will be reviewed according to the following criteria:
- The request for the non-formulary drug is for a condition or medical need not met by existing drugs on THP Rx formulary, OR
- In the physician's medical judgment, the formulary alternatives have been ineffective in the treatment of the member's disease or condition (documentation in the member's clinical record required), OR
- The formulary alternative causes, or is reasonably expected by the prescriber to cause, a harmful or adverse reaction in the member (documentation in the member's clinical record required).
In cases of an emergency when the prescribing physician and/or ESI cannot be contacted, a 72-hour supply of the non-formulary medication can be filled, if necessary. The member will be responsible for the cost; however, the member may submit the receipt to The Health Plan for reimbursement, provided the prescription meets the coverage guidelines.
The information in the pharmacy section of our website is provided for members with prescription coverage only. If you are uncertain about your coverage, please contact our Pharmacy Services Department at 1.800.624.6961, ext. 7914. Medicare Advantage members, please refer to medicare2018.healthplan.org for benefit information.