Pharmacy Program

$4 Prescriptions     Walmart     Target     Hy-Vee Step Therapy Program The following is for South Dakota Plan members only and are for FY 2008. Step Therapy Prior Authorization consists of trials of use and failure to appropriate over-the-counter and formulary alternatives. Step therapy drugs have been determined to be equivalent by the pharmaceutical community depending on diagnosis. Step Therapy Prior-Authorizations are required for the following drugs: Celebrex Step Therapy Prior-Authorization Form - Cox-2 Inhibitor Step Therapy Prior-Authorization Form Proton Pump Inhibitors Formulary - Nexium and Prevacid (Omeprazole) Non-formulary - Prilosec, Zegerid, Aciphex, and Protonix Note: PPI Formulary Changes for FY2008 are different from previous years formulary. Step Therapy Prior-Authorization Form - Proton Pump Inhibitors Step Therapy Prior-Authorization Form Non-sedating Antihistamines Formulary - Allegra (generic Fexofenadine) and Allegra D Non-formulary - Zyrtec, Zyrtec D, Clarinex and Clarinex D Note: NSA Formulary Changes for FY2008 are different from previous years formulary. Step Therapy Prior-Authorization Form - Non-sedating Antihistamines Step Therapy Prior-Authorization Form Weight Loss Medications(Fastin, Ionamin, Meridia, Tenuate, Xenical, Phentermine) Step Therapy Prior-Authorization Form - Weight Loss Medication Step Therapy Prior-Authorization Form NEW! For FY2008 Effective 7/1/07 Leukotriene Receptor Antagonists (Singulair and Accolate) Step Therapy Prior-Authorization Form - Leukotriene Receptor Antagonists Step Therapy Prior-Authorization Form Failure to obtain step therapy prior authorization will result in member paying 100% out of pocket for step therapy medication. Step Therapy Prior Authorization Instructions: Print the appropriate prior authorization form. Have your doctor complete and fax it to HCMTI Pharmacy Program @ 605-731-1905. Please allow 24-48 hours of process time. Generic Prescriptions    Generic Prescriptions Keep More Money in Your Pocket! Mandatory Generic Drug Use Policy Certain health plans require mandatory generic drug use. If your health plan fits into this category and you have a documented medical reason to use the brand name drugs instead of the generic equivalent, you must: First obtain approval from Health Care Medical Technology, Inc (HCMTI) by completing an online exception form referred to as a "Generic to Brand Authorization Form". (Available for South Dakota Plan members only) Print the form Have your prescribing physician Complete the form Submit it to HCMTI for approval via Fax - 605-731-1905 Mail - Health Care Medical Technology, Inc. Attn: Pharmacy Program 2301 West Russell Sioux Falls, SD 57104 If you are currently taking a brand name drug, consult with your doctor to find out if there is a generic equivalent drug available. If no equivalent available, there is no need to complete the Generic to Brand Authorization Form. Pill Splitting Pill Splitting Helps Save Money Pill splitting is a simple procedure and can result in up to a 50% savings of your out-of-pocket expense for prescription medication.  Splitting pills in half also saves the plan 50% of the cost of the prescription. When filling your next prescription, ask your pharmacist to split a higher dosage tablet in half to get your prescribed dosage.  You may then purchase half the number of tablets, at half the cost of your original prescription. Your pharmacist will contact your physician for approval if necessary. For example: If you are taking Lipitor 20 mg per day: have your doctor or pharmacist dispense the next higher dose (in this case it would be 40 mg) You would split to get your 20 mg dosage per day. For a 30-day supply you would get 15 pills to split For a 90-day supply you would get 45 pills to split How to split Pills Your pharmacist may split the pills You can purchase a pill splitter at your local pharmacy HCMTI can send you a top of the line pill splitter (free to all of South Dakota Plan members) Email: pharmacy@hcmti.com ~In this example, approximately $558 can be saved each year by splitting 40 mg Lipitor in half to equal a 20 mg dose.  Your savings would be about $140 of that amount. Benefits You and the plan benefit to obtain a 90-day supply (i.e. 45 pills that you split in half). One co-pay every 3 months, instead of monthly Avoid extra trips to the pharmacy. Please consult your physician or pharmacist for recommendations about these cost-saving interventions for your prescriptions. Refer to the information article on the practice of pill splitting which includes a list of drugs that are appropriate to split. For Pharmacy related questions Phone: (605) 977-0190 Email: pharmacy@hcmti.com Pharmacy Care Technology (PCTI) Overview PCTI is an up-to-date resource for today's ever changing world of Pharmaceuticals. Learn to save yourself and/or your insurance plan money with knowledge of important information such as: generic equivalents brand substitutions over-the-counter alternatives tablet splitting Feel confident and secure about asking questions that are SPECIFIC to your pharmacy concerns. Free tablet splitter to those that enroll! Please visit: www.pharmacycaretechnology.com or contact: 1-866-442-PCTI (7284)