Your Prescription Benefit Program
Welcome to Magellan Rx Management Magellan Rx Management provides a wide range of prescription benefit programs that emphasize quality and cost-effective healthcare solutions, driven to improve overall health. We’re pleased to welcome you to your prescription benefit program. To fill your prescription needs, we offer more than 64,000 pharmacies, representing major chain regional pharmacies and independent stores. To locate a pharmacy, you can visit our website at magellanrx.com or contact one of our Customer Service agents at 1-800-711-4550. Please present your identification card along with your prescription to any participating pharmacy to receive your medication. If you have any questions regarding your prescription benefit program, please call Magellan Rx Management Customer Service at 1-800-711-4550. We are open 24 hours a day, 7 days a week.
An Introduction to Your Prescription Benefit Program Your prescription benefit program is designed to help you and your eligible dependents obtain prescription medications conveniently and at reasonable prices. We are committed to: • Providing a quality prescription benefit program that meets your needs and the needs of your family. • Promoting the use of safe, cost-effective and clinically appropriate medications. • Helping you save money and providing convenient access to your prescription medications. • Helping you achieve the best possible health outcomes.
This booklet is an important resource — along with the Magellan Rx Management website (magellanrx.com) and our Customer Service Department at 1-800-711-4550. We encourage you to review this booklet and visit our website to educate yourself about your prescription benefit program. Understanding how your program works will help you get the most out of your benefit.
Maximizing Your Benefits Generic Medications There are now many generic products available to you on the market. Generic medications provide quality, cost-effective alternatives to brand medications. One or more of your prescriptions may be filled with a pharmaceutically equivalent generic product. We use generic equivalents, whenever possible, in order to reduce costs to you, your Plan and the health care system — unless otherwise directed by your physician. These medications have met the standards established by the Food and Drug Administration (FDA). The FDA approves a generic equivalent if its safety, purity, strength and effectiveness are proven to match that of the brand-name product. Please refer to the label on your prescription container to determine if you have received a generic equivalent.
In general, most plans require the use of generically equivalent products to obtain savings for their members. You may request a brand-name medication by notifying us on your prescription order. The brand-name product may be subject to a higher cost or copay as determined by your Plan.
Over-the-Counter (OTC) Products Some brand-name drugs previously available by prescription-only are now available over-the-counter (OTC). For example, drugs such as Claritin®, Prevacid® 24HR, Prilosec OTC®, and Zyrtec® no longer require a prescription and are the same strength as their prescription versions. These OTC products may represent a reasonable therapeutic alternative to other medications in the same class of drugs that still require a prescription. In consultation with your physician, consider an OTC product as it may be a lower cost option to treat your condition. If your Plan provides OTC coverage, you may be eligible for additional benefits.
Online Resources Health Tools and Information are Just a Click Away Our website, magellanrx.com, is a fast, easy, and secure way for you to compare medication pricing, review prescription benefits in real time, manage your prescription benefit and more-any time of the day or night. This new tool is part of our continued effort to be your “one-stop” shop for all of your healthcare and prescription drug needs. Online tools available at magellanrx.com include: Prescription History, Find a Pharmacy, Drug Information, Drug List, Member Health Education, Drug Pricing Tool, and Medication Reminder.
Mail Service The Mail Order Pharmacy makes ordering maintenance medications easy and can save you both time and money compared to a retail pharmacy. Using your mail order benefit may enable you to receive up to a 90-day supply at a discounted price. Plus, shipping is at no cost to you — so you do not have to drive to your local pharmacy.
Mail service benefits include: • Saving time • Saving money • Convenient door-to-door service
Taking Your Medications As Directed Taking medications exactly as prescribed is one of the most important things you can do to enhance your health and prevent medical complications. Missing doses, stopping medication early or swapping medications with other people can lead to serious problems. Here are a few tips to help you get the greatest benefit from your medications: • Read labels carefully before taking each medication. • Ask your physician or pharmacist what to do if you miss a dose. • Take each medication as prescribed by your physician. For example, take the correct number of doses each day, at the correct time of day. • Talk to your physician or pharmacist before you stop taking a medication. Do not stop taking a medication just because you feel better. • Talk to your physician or pharmacist before crushing or splitting tablets; some medications need to be swallowed whole. • Keep a record of all your current medications, including their names and regimens (dose, time and other instructions). • Write down any problems you have with your medications, and discuss them with your physician or pharmacist. • Keep medications away from heat, light and moisture. Never store medications in the bathroom. • Make taking your medications a part of your daily schedule. • Properly discard all outdated medications. Call Customer Service, visit magellanrx.com, or review FDA guidelines* for information on how to properly discard your outdated medications. *Food and Drug Administration, “How to Dispose of Unused Medicines,” October 2009. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm
Magellan Rx Management Formulary A Prescription Drug List, or formulary, is a list of brand-name and generic medications that have undergone a careful review by a committee of practicing physicians and pharmacists. This committee reviews new and existing medications for safety and efficacy, and decides which medications provide quality treatment at the best value. The formulary is updated several times a year as new medications become available and is subject to change. For the most up-to-date information, or for a full formulary listing, visit magellanrx.com. While the formulary is intended to provide a comprehensive coverage of your prescription medication needs, there are some products that are not covered or have limited availability. For medications that are not on the formulary or are not covered by your prescription benefit program, talk to your physician about alternative medications.
How Can I Find Out What Medications are On My Plan’s Formulary? The Magellan Rx Management Prescription Drug List is updated several times every year as new medications become available. The list is subject to change. For the most up-to-date information, visit magellanrx.com or call Customer Service at 1-800-711-4550. For specific coverage and limitations information, as well as details about your copay, please refer to your benefit plan documents.
Magellan Rx Management Quick Reference Formulary Most Commonly Prescribed Medications All generic medications are listed on the Magellan Rx Management standard formulary. Please use this quick reference list when you receive a prescription. To receive maximum prescription drug benefits, ask your doctor to prescribe a medication on this formulary. Remember, if a preferred drug from the formulary is prescribed, your copay may be less than if a non-preferred drug is prescribed for you. To see the complete Magellan Rx Management standard formulary, visit magellanrx.com, or call toll-free 1-800-711-4550.
Drugs are listed alphabetically by brand name.
Key Lowest Copay = (generics) Middle Copay = Preferred Brand Highest Copay = Non-Preferred Brand* Abilify
Astelin* (azelastine HCL)
Accu-Chek: Aviva Plus, Nano SmartView
Astepro* (azelastine hcl spr)
Accu-Chek Kit Fast Clix Activella* (estradiol/ norethindrone) Actonel* (risedronate sodium)
Androderm AndroGel* (testosterone td gel 1%) Antara* (fenofibrate micronized)
ActoPlus Met (pioglitazone/metformin)
ApexiCon E Cream* (diflorasone diacetate emollient base)
Aricept* (donepezil hydrochloride)
Augmentin* (amox/clav) Avalide* (irbesartanHCTZ) Avapro* (irbesartan) Azopt Azor Benicar, HCT Betagan* (levobunolol) Betopic S
Alphagan P* (brimonidine)
Diovan HCT (valsartan HCTZ)
Calan, SR* (verapamil, SR)
Inderal LA* (propranolol LA)
Duac* (benzoyl peroxideclindamycin)
Indocin, SR* (indomethacin, SR)
Dyazide* (triamterene/ HCTZ)
Isoptin, SR* (verapamil, SR)
Isordil* (isosorbide dinitrate)
Janumet, Janumet XR
Effexor XR* (venlafaxine XR)
Climara* (estradiol patch)
Evista* (raloxifene hcl)
FemHRT* (estradiol/ norethindrone)
Coreg* (carvedilol) Coreg CR
Glucophage, XR* (metformin, ER)
Carac Cardizem* (diltiazem)
Cymbalta* (duloxetine HCL) Detrol, LA* (tolerodine)
Glucotrol, XL* (glipizide)
Lopid* (gemfibrozil) Lopressor* (metoprolol)
Glucovance* (glyburide/ metformin)
Lotrel* (amlodipine/ benazepril)
Dilacor XR* (diltiazem CR)
Hyzaar* (losartan HCT)
Imdur* (isosorbide mononitrate)
Lotensin, HCT* (benazepril/HCTZ)
Maxzide* (triamterene/ HCTZ)
Prempro, low dose
Travatan Z* (travoprost)
Prinzide* (lisinopril/hctz) Pristiq
Trilipix*/choline fenofibrate cap DR
Niaspan* (niacin tab CR)
Verelan* (verapamil SR)
Nitro-Dur (nitroglycerin patch)
Renvela* (sevelamer carbonate)
Wellbutrin, SR* (bupropion)
Metaglip* (glipizide/ metformin) Mirapex* (pramipexole) Myrbetriq Nalfon* (fenoprofen) Namenda Naprosyn* (naproxen)
Nitrostat Norpramin* (desipramine) Norvasc* (amlodipine) Novofine needle Novolin Novolog, mix
Wellbutrin XL* (bupropion XL)
Ortho Evra* (norelgestromin-ethinyl estradiol td)
Ortho Tri-Cyclen Lo
Testim* (testosterone td gel 1%)
Timoptic XE* (timolol, XE)
Toprol XL* (metoprolol XL)
Nuvaring OneTouch: Ultra 2, UltraMini, Verio IQ
Zomig, ZMT* (zolmitriptan) Zyprexa* (olanzapine) Zyprexa Zydis* (olanzapine ODT)
Note: This is a partial list of medications that changes periodically. To ensure you have the most current version of the standard formulary, visit magellanrx.com, or call toll-free 1-800-711-4550. Inclusion of a medication on this formulary is not a guarantee of coverage. Please refer to your plan of benefits for coverage limitations and exclusions. Not all benefits plans in all states are subject to quantity limits. For details regarding quantity limits for your particular benefits plan, contact Customer Service at the telephone number listed on your identification card.
Additional Requirements for Coverage or Limits on Certain Medications May Include: Prior Authorization Your prescription benefit program may have a prior authorization process for certain medications. Prior authorization is a requirement that your physician obtain approval from your health plan to prescribe a specific medication for you. Without this prior approval, your health plan may not provide coverage for your medication. If your physician prescribes a medication requiring a prior authorization, you will need to go through a prior authorization process. We review requests for these selected medications to help ensure appropriate and safe use of medications for your medical condition(s). Your physician can call, fax, or submit prior authorization requests electronically. For a list of select medications that require prior authorization, please contact Customer Service at 1-800-711-4550.
Quantity Limits and Step Therapy Your Plan may have additional requirements for coverage or limits for select prescription medications. These requirements and limits ensure that members use these medications in the most effective way and also help the Plan control medication costs. A team of practicing physicians and pharmacists developed these requirements and limits to help your Plan provide quality coverage to members. Please consult the formulary on our website for more information.
Quantity Limits For certain medications, your Plan may limit the amount of the medication that will be covered per prescription or for a defined period of time. For example, your Plan may provide up to 30 units per 30-day period for a formulary medication.
Step Therapy In some cases, your Plan requires you to first try one medication to treat your medical condition before it will cover another medication for that condition. For example, if Drug A and Drug B both treat your medical condition, your Plan may require your physician to prescribe Drug A first. If Drug A does not work for you, then your Plan will cover Drug B. You can find out if the medication you take is subject to these or other additional requirements or limits by looking in the current formulary on magellanrx.com, or by calling Customer Service at 1-800-711-4550.
Magellan Rx Management Contact Information Departments/Services for Members Website
Customer Service (For the hearing impaired)
National TRS, Dial 711 (Provide 800# above)
Departments/Services for Physicians Prior Authorization
Phone: 1-800-711-4550, Press option 4 Fax: 1-800-424-3260
Department Hours Customer Service
24 hours a day, 7 days a week
In Case of Emergency In the event of an emergency or natural disaster, contact Customer Service for assistance. We will help you obtain an immediate refill at a local pharmacy if needed.
Medications List Allergies to Medications Use the chart below to list all medications, both prescription and nonprescription, to which you are allergic. Medication
Type of reaction, such as rash or breathing difficulties.
Prescription Medications Use the chart below to list all brand name and generic prescription medications you currently take. Be sure to fill in all the information for each medication. The amount of medication in each pill appears on the prescription label in milligrams (mg). The dosage is the amount of medication in each pill multiplied by the number of pills you take at one time.
Reason for taking the medication
How often? Dosage
(such as 3x/ day)
Reason for taking the medication
How often? Dosage
(such as 3x/ day)
About Magellan Rx Management We’re providing a smarter approach to pharmacy benefits – our integrated solution combines comprehensive prescription benefits management (PBM) services with specialty pharmacy expertise. We help members by providing safe and effective prescription drugs at the lowest total cost. Welcome to a unique vision of care. Welcome to Magellan Rx Management.
How to Find Information About Your Plan For the most up-to-date information about your prescription benefit program, visit us online at magellanrx.com or call Customer Service at 1-800-711-4550.