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When you give a prescription to a network pharmacy, we tell
the pharmacy, using a special computer system, whether or not
the drug is on our formulary and whether or not it requires
prior authorization. The pharmacy will then tell you if the
drug is not on the formulary or if it requires prior authorization.
Your pharmacy will call the provider who gave you the prescription
and will call PerformRx, our pharmacy benefit manager, to decide
what to do.
- If the pharmacy cannot reach your provider, the pharmacy
will give you a temporary supply of the drug that your provider
prescribed. You will receive a five-day supply of the drug
if it is one that you have never received before or have not
taken in a while. You will receive a 15-day supply if it is
a medication that you are currently taking. Passport Advantage
will then call your provider to determine if the provider
will prescribe a drug on the formulary, request an exception
to the formulary, or request prior authorization.
- If the pharmacy does reach your provider and your provider
refuses to prescribe a drug on the formulary, the pharmacy
will give you a five-day supply of the drug that your provider
prescribed. Passport Advantage will then call your provider
to explain how the provider can request an exception to the
formulary.
- If your provider would like to request an exception to the
formulary or to request prior authorization, your provider
should complete the Exception
and Prior Authorization Form and fax it to PerformRx at
866-369-6038 for a standard request or 866-533-5491 for an
urgent request.
- A PerformRx clinical pharmacist will review the form and
decide whether or not to approve the request.
- If PerformRx agrees with your provider's request, we will
notify your provider and your pharmacy of the decision so
that you may fill the prescription.
- If PerformRx does not agree with your provider's request,
PerformRx will contact Passport Advantage. One of Passport
Advantage's Medical Directors will consider the request.
- If Passport Advantage agrees with your provider's request,
we will notify your provider and your pharmacy so that you
may fill the prescription. Prior authorizations last six months.
- If Passport Advantage does not agree with your provider's
request, we will fax your provider a letter and we will mail
you a letter to tell you why we do not agree and to tell you
how you can ask us to review our decision.
- To learn more about how you can ask us to review our decision,
read our Appeals and
Grievances Policy.
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