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Do you want to know if your prescription medication is covered by CitrusCare plan? Our formulary is a list of drugs, both brand names and generics which are covered by the Citrus Health Care. The medications listed on the following formularies have been reviewed by the our Pharmacy and Therapeutics (P&T) committee, and have been established to be appropriate for formulary inclusion on the basis of safety, efficacy, approved indications, ease of use, potential for adverse effects, and cost effectiveness.
If your drug is not covered and you would like to learn about alternatives that may save you money on your prescriptions, please call 1-866-769-1157 or for the hearing impaired TTY/TDD 1- 888-248-7875 Monday – Friday, 8:00 AM – 8:00 PM Eastern Time.
Generic: These are drugs that have the same active ingredients as a brand name medication. Generics usually cost less than brand name drugs and are rated by the Food and Drug Administration to be as safe and effective as brand name drugs.
Brands Plus: These are drugs that are covered during the donut hole for certain plans
Preferred Brand Drugs: These are brand name drugs that are preferred by Citrus Health Care.
Non-preferred brand drugs: Although these drugs are not on Citrus Health Care’s preferred brand list you can continue to use these drugs but may have to pay more money out of pocket.
2 CFR 423.120(b)(5)iii:
Part D sponsors may immediately remove from their Part D plan formularies covered Part D drugs deemed unsafe by the Food and Drug Administration or removed from the market by their manufacturer without meeting the requirements of paragraphs (b)(5)((i)) of this section. Part D sponsors must provide retrospective notice of any such formulary changes to affected enrollees, CMS, State Pharmaceutical Assistance Programs, entities providing other prescription drug coverage, authorized prescribers, network pharmacies and pharmacists consistent with the requirements of paragraphs (b)(5)(ii)(A), (b)(5)(ii)(B), (b)(5)(ii)(C), and (b)(5)(ii)(D) of this section.
Out of Network Pharmacy Coverage
Citrus Health Care uses a network of pharmacies through our Pharmacy Benefit Manager, National Pharmaceutical Services (NPS). You must use a network pharmacy to receive benefits. We may not pay for your prescription if you use a non-network pharmacy, except in certain circumstances.For example, if you become ill while traveling outside of our service area, and there are no network pharmacies available. If this happens you will have to pay the full cost rather that the co-payment when you fill your prescription. You may also be asked to pay the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged you for your medications. You can request reimbursement by submitting a paper claim to NPS. We have network pharmacies in all 50 states and Puerto Rico.
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