medications for male impotency, and
growth hormones for persons age 21 or older.
The quantity of some prescription drugs may be limited based on medical necessity. Some prescription drugs are indicated only for a specific therapeutic period or in certain amounts. If the quantity of a covered prescription drug, as prescribed by the physician, is not approved by Catalyst Rx, the physician must contact Catalyst Rx for prior approval of additional quantities. Approval will require appropriate documentation of medical necessity.
The fact that a physician has prescribed, ordered, recommended, or approved a prescription drug, does not, in itself, make the prescription drug medically necessary for purposes of coverage under the Plan.
Step Therapy Some prescription drugs require step therapy. Step therapy is a process that optimizes rational drug therapy while controlling costs by defining how and when a particular drug or drug class should be used based on a patient’s drug history. Step therapy requires the use of one or more prerequisite drugs that meet specific conditions prior to the use of another drug or drugs.
Early Refills There are some circumstances when a participant will be allowed to obtain an early refill of a prescription drug for purposes such as going on vacation, for a dosage change during the course of a treatment, or for lost or destroyed medication. The participant’s pharmacist may contact Catalyst Rx to obtain authorization for an early refill or advance supply of a medication. Early refills are limited to two refills per medication per year.
Walgreens Specialty Pharmacy Program Catalyst Rx has partnered with Walgreens Specialty Pharmacy to provide a dedicated specialty pharmacy program for participants who are receiving specialty medications. Through the Catalyst Rx/Walgreens program, participants will enjoy increased convenience through the availability of specialty prescription pickup at more than 4,000 retail Walgreens stores, at the physician’s office, or via home delivery mail service. The participant will pay a $30 co-pay for each 30 day supply subject to the applicable deductible. For additional information, please contact 1-888-782-8443
Walgreens Specialty Pharmacy Program provides medications for many chronic conditions, including the following:
Multiple Sclerosis Gaucher’s Disease Hepatitis C Respiratory Syncytial Virus Crohn’s Disease Pulmonary Hypertension
Rheumatoid Arthritis Cystic Fibrosis Anemia Growth Hormone Deficiency Neutropenia