Understand how our coverage works with different types of prescriptions. Formulary Tier Exception Member Request Form PHYSICIAN ONLY COMPLETES Cardholder Identification Number.
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Your cost share The cost of drugs varies.
Fepblue org formulary. 11212019 33458 PM. This includes information about. 3 1 Review this abbreviated formulary to learn how to get the most from your pharmacy benefit.
Formulary Tier Exception Member Request Form Service Benefit Plan Attn. The formulary is a list of your covered prescription drugs. The formulary is a list of prescription drugs covered on your plan.
Frequently asked general pharmacy questions. FEP Formulary Prescription Drug List and Costs. Phoenix AZ 85072-2080.
The formulary has 5 tiers of drugs. Box 52080 Phoenix AZ 85072-2080 FAX. Send completed form to.
Previously you paid 30 of our allowance. The protection of your privacy will be governed by the privacy policy of that site. You will be going to a new website.
The out-of-pocket catastrophic maximums increased to 7500 for Self Only and 15000 for Self One and Self Family contracts. NUnderstanding the Formulary nHow to use the Abbreviated Formulary nAbbreviated Formulary nManaged Not Covered Drugs nExcluded Drug List. 2021 FEP Blue Focus Formulary.
We also made changes to our approved drug lists formularies. Prescrib erC tif ca on. Select the list of exceptions for your plan.
INTRODUCTION FEP is pleased to provide the 2021 FEP 5 Tier Managed Rx Drug Formulary as a useful reference for drug product selection. 2020 Standard Option Formulary. I c erti fy that am t ph si a n andl orm tio p ovi is m to bu rr ct to of my knowledge and belief.
It includes both generic and brand name drugs. The Formulary Exception process allows members to apply for coverage of a non-covered drug if they have tried and failed the covered drugs. See how your Service Benefit Plan coverage works with different types of prescription drugs.
1-800-273-5357 If you are requesting a copay exception for more than one medication please use a separate form for eachmedication. INTRODUCTION FEP is pleased to provide the 2021 FEP 5 Tier Rx Drug Formulary as a useful reference for drug product selection. Familiarize yourself with the specifics of your plans formulary.
FEP Blue Focus Formulary 907 Effective April 1 2021 The FEP formulary includes a preferred drug list which is comprised of Tier 1 generics and Tier 2 preferred brand-name drugs preferred generic specialty drugs and preferred brand-name specialty drugs. Phoenix AZ 85072-2080. Ask your physician if there is a generic drug available to treat your condition.
Also included in the formulary are Tier 3 non-preferred brand-name drugs Tier 4 preferred specialty drugs and Tier 5. It includes generic brand name and specialty drugs as well as Preferred drugs that when selected will lower your out-of-pocket costs. Whats New for 2021 FEP Benefit Plans.
Service Benefit Plan. 3 REVIEW THIS ABBREVIATED FORMULARY TO LEARN HOW TO GET THE MOST FROM YOUR PHARMACY BENEFIT SUCH AS. 1 FEP 5 Tier Rx Drug Formulary 807 Basic Option Effective June 27 2014 The FEP formulary includes the preferred drug list which is comprised of Tier 1 generics and Tier 2 preferred brand-name drugs.
N Understanding the Formulary n How to use the Abbreviated Formulary. You will be going to a new website operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party.
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