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.

Item Last Updated: 29 September 2017 11:22 CST

 

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.

Item Last Updated: 29 September 2017 11:24 CST

 

Quick Reference List

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

Item Last Updated: 29 September 2017 11:27 CST

 

Pharmacy Locator

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

Item Last Updated: 31 March 2016 11:12 CST

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.
Item Last Updated: 31 March 2016 11:12 CST

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. 

Item Last Updated: 26 April 2016 15:13 CST

 

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

Item Last Updated: 29 March 2016 16:10 CST

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.

Item Last Updated: 26 September 2016 12:46 CST

 

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

Member Services

If you have a question about your health plan, please call Member Services.  Hours are 8 a.m. to 5 p.m. Monday through Friday and 9 a.m. to 1 p.m. Saturday.


Si tiene preguntas sobre su plan de salud, por favor llame a la línea de Atención a Miembros Participantes. Horario de 8 a.m. a 5 p.m. de Lunes a Viernes y Sábado de 9 a.m. a 1 p.m.

1-888-FHN-4YOU
(346-4968)
TTY: 711

FLU Season

Flu season begins in October and lasts as late as May. Talk to your doctor about getting a FREE flu shot today.

Click here for more information

Service Area

FHN serves people living in the Chicago area: including Cook, DuPage, Kane, Kankakee, Lake and Will Counties.

Service outside of our Service Area

If you are not in our service area and you need care but it is not an emergency, please call us at 1-888-346-4968 TTY: 711. We will work with you to help you get the care and services you need. When FHN helps to arrange non-emergency services for you outside its service area, we will cover the cost. If you get services outside of our coverage area, we may not pay for those services.
If you are not in our service area and you need emergency care, call 911 or go to the nearest hospital.