Pharmacy Benefits Program

Family Health Network is committed to providing appropriate, high-quality, and cost-effective drug therapy to our members. We cover prescription medications and certain over-the-counter medications with a written prescription from their practioner. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. FHN has chosen CVS Caremark as its Pharmacy Benefits Manager (PBM). Our members do not have a co-pay for covered medications.

Pharmacy Formulary and Pharmacy Management Procedures

The first section of this document describes the formulary management procedures including, but not limited to, generic medications, exception requests for formulary and non-formulary drugs, quantity limits, step therapy, therapeutic interchange and specialty medications. It is followed by the formulary list of drugs with notations where appropriate. The formulary includes information on restrictions and preferences. Press here to view the Pharmacy Formulary and Pharmacy Management Procedures.

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Over-the-Counter List

Many over-the-counter drugs are covered under the FHN Formulary with a prescription from the prescriber. See the Over-the-Counter list.

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Quick Reference List

The Quick Reference List (QRL) is a listing of formulary medications by therapeutic categories.

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Pharmacy Locator

The Pharmacy Locator allows anyone to locate an in-network pharmacy most convenient to the member.

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Drug Reference and Interactions

CVS Caremark provides this tool to provide information to both prescribers and members. It includes information regarding:

  • Drug/drug interactions
  • Side effects and risks of the drugs
  • Generic substitutions available for a brand name drug. Family Health Network requires the use of generic drugs whenever they are available.
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Formulary Exception/Prior Authorization Form

The formulary exception/prior authorization process is used to ensure that some medications are being used for a medically-approved indication. Medications requiring formulary exception/prior authorization may include, but are not limited to, prescription drugs specified by Family Health Network, brand-name medications with a generic equivalent, specialty medications, medications with age limitations, and medications prescribed for a quantity exceeding normal limits. The CVS Caremark formulary exception/prior authorization professional staff evaluates the practitioner’s request based on predefined clinical criteria.

You may initiate the Formulary Exception/Prior Authorization process by any one of the three methods below:

  • Complete the formulary exception/prior authorization form in the attached link 
  • Call CVS Caremark at (855) 293-4114 , request a Formulary Exception/Prior Authorization
  • By using ePA (Electronic Prior Authorization) via CoverMyMeds

CVS Caremark will notify the practitioner and the member by written communication of the final decision. 

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90 Day Medication List

To improve adherence to medication, FHN encourages prescribers to prescribe a 90 day supply of maintenance medications for the member once the medication has proven beneficial for the member. 
90 Day Maintenance Medications

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Pharmacy Updates & Notices

Medication Safety Alerts and Recall Notices

Keeping your patients safe is our first priority. The most up-to-date medication safety alerts and medication recalls can be found here.

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For additional information call CVS Caremark 24 hours a day at (877) 293-4114 or Family Health Network Member Services at (888) 346-4968