2018 List of Covered Drugs

284 Pages·2017·4.36 MB·English

Centers Plan for FIDA Care Complete
(Medicare-Medicaid Plan)
2018 List of Covered Drugs (Drug List)
This formulary was updated on 01/01/2018. If you have questions, please call Centers Plan for FIDA Care
Complete’s pharmacy help line at 1-888-266-7460, seven days a week from 8 a.m. to 8 p.m. TTY users call
1-800-421-1220. The call is free.
For More Informaton, visit
www.centersplan.com/fda
Efectve Date: 01/2018
Last Updated: 01/2018
Formulary ID: 18001, Version #11
H3018_16702_CY2018_DrugList_V3_Rev_FINAL
Centers Plan for FIDA Care Complete
(Medicare-Medicaid Plan)
2018 List of Covered Drugs (Drug List)
This formulary was updated on 01/01/2018. If you have questions, please call Centers
Plan for FIDA Care Complete’s pharmacy help line at 1-888-266-7460, seven days a
week from 8 a.m. to 8 p.m. TTY users call 1-800-421-1220. The call is free.
For More Information, visit www.centersplan.com/fida/
Effective Date: 01/2018
Last Updated: 01/2018
Formulary ID: 18001, Version # 11
If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. i
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ATTENTION: If you speak English, language assistance services, free of charge,
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are available to you. Call 1-800-466-2745 (TTY: 1-800-421-1220).
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asistencia lingüística. Llame al 1-800-466-2745 (TTY: 1-800-421-1220).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-466-
Chinese
2745（TTY：1-800-421-1220）。
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If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. ii
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gjuhësore, pa pagesë. Telefononi në 1-800-466-2745 (TTY: 1-800-421-1220).
If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. iii
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Centers Plan for FIDA Care Complete | 2018 List of
Covered Drugs (Formulary)
This is a list of drugs that Participants can get in Centers Plan for FIDA Care Complete.
❖ Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan) is a managed care
plan that contracts with both Medicare and the New York State Department of Health
(Medicaid) to provide benefits of both programs to Participants through the Fully
Integrated Duals Advantage (FIDA) Demonstration.
❖ The List of Covered Drugs and/or pharmacy and provider networks may change
throughout the year. We will send you a notice before we make a change that affects
you.
❖ Benefits may change on January 1 of each year.
❖ You can always check Centers Plan for FIDA Care Complete’s up-to-date List of
Covered Drugs online at www.centersplan.com/fida/ or by calling Centers Plan for
FIDA Care Complete Participant Services at 1-888-266-7460 (TTY users call 711 or 1-
800-421-1220).
❖ Limitations and restrictions may apply. For more information, call Centers Plan for
FIDA Care Complete Participant Services or read the Centers Plan for FIDA Care
Complete Participant Handbook. This means that you need to follow certain rules to
have Centers Plan for FIDA Care Complete pay for your services.
❖ There are no copays for any covered drugs.
❖ If you speak English, language assistance services, free of charge, are available to
you. Call 1-888-266-7460 (TTY: 711 or 1-800-421-1220), seven days a week from 8
a.m. to 8 p.m.
如果您使用中文，您可以免費獲得語言援助服務。請致電 1-888-266-7460（聽力障礙
電傳：711 或 1-800-421-1220)，工作時間為每週 7 天，每天早上八點到晚上八點。
Si ou pale Kreyòl Ayisyen, wap jwenn sèvis asistans lang, gratis, disponib pou ou.
Rele 1-888-266-7460 (TTY: 711 oswa 1-800-421-1220), sèt jou pa semèn apati 8 a.m.
rive 8 p.m.
Se lei parla italiano, può avvalersi dei servizi gratuiti di assistenza linguistica.
Chiamare il numero 1-888-266-7460 (TTY: 711 o 1-800-421-1220), sette giorni su
sette, tra le ore 8 e le 20.
한국어 를 사용하는 경우 무료로 언어 지원 서비스를 받을 수 있습니다. 문의: 1-888-
266-7460 (TTY: 711 또는 1-800-421-1220), 연중무휴 오전 8시-오후 8시.
If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. v
Если вы говорите по-русски, вам доступна бесплатная языковая поддержка.
Звоните 1-888-266-7460 (номер для пользователей телетайпа (TTY): 711 или 1-
800-421-1220) с 8:00 до 20:00 в любой день недели.
Si habla español, tiene a su disposición servicios de asistencia lingüística, sin costos.
Llame al 1-888-266-7460 (TTY: 711 o 1-800-421-1220), los siete días de la semana,
de 8 a.m. a 8 p.m.
❖ You can get this document for free in other formats, such as large print, braille, or
audio. Call 1-800-466-2745 (TTY: 711 or 1-800-421-1220), seven days a week, from 8
a.m. to 8 p.m. The call is free.
❖ Centers Plan for FIDA Care Complete wants to make sure you have access to plan
materials in your preferred language. So, when you call, we’ll ask you for your
preferred reading language and whether or not you want your materials in that
language. We might also reach out to you once or more a year to make sure the
information we have on file about your preference is correct. Of course, you are
always able to make changes to your preference by:
• Speaking with a live representative at 1-800-466-2745 (TTY: 711 or 1-800-421-
1220 or), seven days a week, from 8 a.m. to 8 p.m.;
• Sending a letter to us at: Centers Plan for FIDA Care Complete, Attention:
Participant Services, 75 Vanderbilt Avenue, Staten Island, NY 10304; or
• Emailing us at
Frequently Asked Questions (FAQ)
Find answers here to questions you have about this List of Covered Drugs. You can read
all of the FAQ to learn more, or look for a question and answer.
1. What prescription drugs are on the List of Covered Drugs?
(We call the List of Covered Drugs the “Drug List” for
short.)
The drugs on the List of Covered Drugs that starts on page 3 are the drugs covered by
Centers Plan for FIDA Care Complete. These drugs are available at pharmacies within
our network. A pharmacy is in our network if we have an agreement with them to work
with us and provide you services. We refer to these pharmacies as “network pharmacies.”
 Centers Plan for FIDA Care Complete will cover all drugs on the Drug List if:
• your doctor or other prescriber says you need them to get better or stay healthy,
• the drug is medically necessary for your condition, and
• you fill the prescription at a Centers Plan for FIDA Care Complete network
pharmacy.
 Centers Plan for FIDA Care Complete may have additional steps to access certain
drugs (see question #5 below). In some cases, you may have to do something before
you can get a drug, like try other drugs first.
You can also see an up-to-date list of drugs that we cover on our website at
www.centersplan.com/fida/ or call Participant Services at 1-888-266-7460, TTY users call
711 or 1-800-421-1220.
2. Does the Drug List ever change?
Yes. Centers Plan for FIDA Care Complete may add or remove drugs on the Drug List
during the year. Generally, the
Drug List will only change if:
• a new drug comes along that works as well as a drug on the Drug List now, or
• we learn that a drug is not safe.
We may also change our rules about drugs. For example, we could:
If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. vii
• Decide to require or not require prior approval for a drug. (Prior approval is
permission from Centers Plan for FIDA Care Complete or your Interdisciplinary
Team (IDT) before you can get a drug.)
• Add or change the amount of a drug you can get (called “quantity limits”).
• Add or change step therapy restrictions on a drug. (Step therapy means you must
try one drug before we will cover another drug.)
(For more information on these drug rules, see page ix.)
We will tell you when a drug you are taking is removed from the Drug List. We will also
tell you when we change our rules for covering a drug. Questions 3, 4, and 7 below have
more information on what happens when the Drug List changes.
 You can always check Centers Plan for FIDA Care Complete’s up to date Drug List
online at www.centersplan.com/fida/. You can also call Participant Services to check
the current Drug List at 1-888-266-7460.
3. What happens when a cheaper drug comes along that
works as well as a drug on the Drug List now?
If a cheaper drug becomes available that works as well as a drug on the Drug List now:
• Your pharmacist may give you the cheaper drug the next time you fill your
prescription. If you and your provider decide that the cheaper drug is not right for
you, your provider can tell the pharmacist to continue to give you the drug you
take now.
• Centers Plan for FIDA Care Complete may decide to take the more expensive
drug off of the Drug List. If you are taking a drug that we remove from the Drug
List because a cheaper drug that works just as well comes along, we will tell you
at least 60 days before we remove it from the Drug List or when you ask for a
refill. Then you can get a 60-day supply of the drug before the change to the Drug
List is made. If we decide to remove a drug from the list, we will notify you in
writing and/or by phone at least 60 days before we remove the drug from the list.
4. What happens when we find out a drug is not safe?
If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will
take it off the Drug List right away. We will also send you a letter and call you to tell you
If you have questions, please call Centers Plan for FIDA Care Complete at 1-888-266-7460
(TTY: 711 or 1-800-421-1220), seven days a week from 8 a.m. to 8 p.m. The call is free. For
? more information, visit www.centersplan.com/fida. viii