Pharmacy Overview - Altius Health Plans
PREFERRED DRUG LIST
Formulary Suggestions for common
Injectible Medications Purchased
Recent Changes to the Preferred
The purpose of the
pharmacy program is to provide high quality drug therapies to our members while
ensuring positive health outcomes at an affordable cost.
The pharmacy benefit will allow members and their dependents to obtain
prescription medications from Altius contracted pharmacies or our Prescription
Mail Service. This benefit includes birth control pills, insulin, glucose test
strips, lancets and insulin syringes.
FILLING A PRESCRIPTION
A thirty (30) day supply of medications (unless redefined by Altius Health Plans
Preferred Prescription Drug List, mail order pharmacy service, State or Federal
Law, or manufacturer's package size) prescribed by a Provider can be filled by
presenting an Altius Health Plans Membership card to any contracted pharmacy.
When obtaining a prescription, a member will pay the prescription drug
co-payment listed on the Altius Health Plans Membership card or in their medical
As a member of Altius Health Plans, you must receive your prescription
medication from Altius contracted pharmacies. You can consult your Altius
Regional Provider Listing for the names of contracted pharmacies or call Altius
Customer Service Department at (801) 323-6200.
If a member requires a prescription medication while outside the Altius Service
Area, members may contact Express-Scripts Inc. Customer Service Department toll
free at 1-800-698-0149 for the nearest contracted pharmacy. Members may also pay
fee for service for a prescription and mail their information along with
receipts to Express-Scripts. Inc. for reimbursement. Members may also contact
Express-Scripts Inc. Customer Service Department to obtain forms and
MAKING YOUR PREFERRED DRUG LIST
WORK FOR YOU
using your Altius Preferred Drug List can save you time and money!
Take this list with you when you visit your
preferred medications are available at lower copays. By getting a
prescription for a preferred medication at your physician's office you can
avoid delays at the pharmacy.
What about generics?
Ask your physician or pharmacist if your prescription is available in a
therapeutically equivalent generic. Most Altius plans allow for a lower
copay for generic medications and your physician or pharmacist will be happy
to answer any questions.
What if my medication is not on the list? Talk to your physician about a formulary alternative. The Altius’ Preferred
Drug List provides sound clinical choices for all disease states, yet,
non-preferred brand name medications require the highest copay.
How do I keep my monthly prescription costs
under control? Good question! First, work with your physician to choose medications that
are on the preferred list and choose generics when possible. Second, check
out the mail order program. Some maintenance medications are available
through the mail order program at only 2, or 3 copays for a 3 month (90 day)
supply. Check your benefit brochure for the details of your plan. That’s
savings delivered right to your door!
I’ve never heard of a formulary before. What is it?
One way to manage your prescription benefit is with a formulary. A formulary, or
list of preferred medications, was developed by a committee of pharmacists and
physicians to include drugs that are the safest, most effective, and most
economical. This committee meets regularly to discuss new drugs and trends in
drug therapy. The formulary list may change periodically to reflect their new
findings. To ensure the use of the appropriate drugs at the most cost effective
prices, you will have the option of using the formulary list of the preferred
brand name and generic medications at lower coinsurance amounts. Drugs from the
formulary provide a safe, effective, and affordable alternative to non-formulary
drugs, which will cost you more.
My pharmacist recommends I use a generic drug instead of the brand my
physician prescribed. Is this recommended?
A generic drug is the term used to describe a drug once the original drug
manufacturer’s brand name patent has expired. Generic drugs tend to cost less
since many of the research, development, and marketing costs have been paid by
the original manufacturer. Each generic drug manufacturer must meet the same
strict FDA guidelines followed by the original brand name manufacturer. In
general, most generic drugs are considered part of the formulary, even though
they are not listed. It is important to note that the formulary will not
restrict your access to medications. It simply requires that you pay more if you
want brand name drugs that are not on the formulary. To save you money, we
encourage you to use generic drugs whenever possible. When your doctor is
prescribing a new medication, you should ask if a generic drug is available and
appropriate for your condition.
So how can I keep my drug costs down?
Bring a copy of the formulary with you when you visit
the doctor. It will be much more efficient for the doctor to pick a drug
from the list than to change the prescription after you try to have it
Ask for generic drugs whenever they are available. The
FDA has systems in place to assure that the medications are the same
strength and quality as the brand name drugs and that they will act the same
way in your body.
Consider having your maintenance medications filled at
the mail order to conserve on the amount of money you pay as co-payment.
Alternatively, you could use the Express Scripts internet pharmacy by simply
logging on to Express Scripts to order your prescriptions.
Use a pharmacy in the network.
What is a Generic Name
for a drug? I
thought I was getting a brand name drug.
All drugs must have a generic name assigned at the time of FDA approval. This
allows pharmacists and doctors better understand the classification of drugs on
the market. Think of it in terms of a common OTC drug such as aspirin. There are
many brands of aspirin on the market, but they all have the same generic name of
QUANTITY LEVELS ON MEDICATIONS
Altius Health Plans has
placed quantity levels on select medications. This is to ensure that our members
receive the recommended and proper dose and length of therapy for their specific
disease state. Also, this program will ensure patients graduate to more cost
Medications with quantity levels will be limited to the FDA and Altius’ Pharmacy
and Therapeutics Committee’s recommendations per each refill or month.
medications need prior-authorization from Altius before they can be dispensed.
These drugs were chosen due to their high potential for adverse reactions,
contraindications, potential for abuse and cost. Medications that require prior
authorization are listed below. You or your physician may contact Altius’ Prior
Authorization Department at (801) 323-6440 or 1-800-879-0234 for an
authorization form to be faxed to your provider or his/her office. Your provider
must complete the request and fax it back to the Prior Authorization Department
for an authorization review. Approval or denial will be communicated to your
provider. You may also phone the Prior Authorization Department for a status of
The prescription mail
order service program allows a member to receive a 90-day supply of maintenance
medication while only paying one, two or three co-payments, depending upon your
prescription benefit. Refer to your benefit brochure for the details of your
What does "maintenance medication" mean? A maintenance medication is any
prescription that is defined by Altius to be taken on a daily basis. Examples
include but are not limited to medications for blood pressure, asthma,
antidepressants, oral anticoagulants, diabetes, hormone replacement and birth
Non-maintenance medications are not available through mail order and
include antihistamines (Allegra, Claritin and Zyrtec), antibiotics, pain
management (hydrocodone), muscle relaxants, anti-migraine, medications for sleep
or anxiety (alprazalam, Ambien and diazepam), acne preparations and topical
creams and ointments. The Preferred Drug list identifies non-maintenance
medications with an asterisk (*).
Mail Order is Easy!
Obtain from your physician a new prescription for a
90-day supply for each medication or refill (when the prescription has
Fill out and mail the Mail Pharmacy Service form,
available from Altius customer service at
Express Script Customer service at 1-800-698-0149.
You will receive your medications in about 14 days.
Since this can take up to two weeks make sure you have a sufficient quantity
on hand (a 2-week supply) so you don’t run out while waiting for your
medication to arrive in the mail.
You may access the status of your order by contacting
Express-Scripts Inc. web site. Go to
Member Services and then Mail Service Refills.
What about refills?
Three weeks before your medication is gone, simply
call the 24-hour refill line,
If you try to refill your prescription too soon,
Express Scripts will not recognize the refill order and you will need to
request it again when you are within 3 weeks of the refill date. This
includes new prescriptions being mailed in or phoned-in requests from your
If you prefer using
the internet for your refills, you may visit Express Scripts' Mail Service
Pharmacy. And follow their online directions. New prescriptions must be mailed
or phoned in by your physician.
Prescriptions may only be filled for a 30-day supply of medication unless
redefined by Altius Health Plans' Preferred Drug List, mail pharmacy service,
State or Federal laws or manufacturer's package size.
Hospital discharge prescriptions must be filled at an Altius Health Plans
The following medications will be excluded from Altius Health Plan's pharmacy
Over the counter medications
Medications for non-approved FDA indications or
non-approved indications as determined by Altius Health Plans.
Injectible, except insulin, Imitrex, Glugagon, Lovenox
and Epi-pen (bee sting kits)
Natural progesterone (including suppositories and
Smoking cessation products
Therapeutic devices or support garments (May be
covered as a medical benefit)
Skin patches for motion sickness.
Medications or nutritional supplements for weight loss
or weight gain for non-medical conditions.
Immunizations and medications required exclusively for
RELENZA and Tamiflu
Hair growth products
Medications for athletic and mental performance
Medications for the treatment of nail fungus.
Impotence medications, unless specifically included in
a specific Altius Health Plans' Pharmacy Benefit.
Avita, Renova, Propecia, Zyban, Potaba, Xenical,
Meridia, Vaniqua, Sarafem & Aggrenox
VITAMINS (except prescription prenatal vitamins)
Compounded estrogen, testosterone cream & suppositories
Home | Up
250 two party hospital deductible
Altius Two Party Rates
Altius pharmacy overview