OHA: MC Prescription Questions

Managed Care

My managed care plan physician has given me several prescriptions that I need to fill. Can I go to my pharmacy and do I need a separate identification card for these services?

Your plan should provide you with a listing of participating pharmacies that you must access for prescription coverage. You can usually get this list by calling the plan, accessing the plan's website or calling the pharmacy. Some plans use one identification card for both medical and pharmacy services while others have a separate card with a different identification number. Be sure to have the appropriate identification card before you visit the pharmacy.


The information provided by my managed care plan states they have a prescription mail order option. What does that mean?

Most managed care plans provide this service and some might require you to use the mail order company to fill your prescriptions in order to receive any pharmacy coverage. Usually calling in or mailing your prescriptions to such a service will provide you with several months of drugs for one co-payment charge (rather than, for example, one co-payment charge for one month's supply of drugs). Follow the directions outlined in the plan's materials regarding prescription mail order services.


What's the difference between "brand name" and "generic" prescriptions? Do I have a choice of which I receive through my plan?

A generic drug is a chemically equivalent copy designed from a brand name drug that has an expired patent. A generic is typically less expensive and sold under a common or "generic" name for that drug, not the brand name. Your plan should provide you with direction as to how they cover brand name and generic drugs. Usually there is a higher co-payment charge for dispensing brand name drugs, as they are more expensive than their generic counterparts.


My managed care plan has a formulary with its prescription plan. What does that mean and how might it affect me?

A drug formulary is a listing of prescription medications which are approved for use and/or coverage by the plan and which will be dispensed through participating pharmacies to a covered enrollee. Any further questions about the drugs covered or denial of prescription services should be referred to the Consumers Affairs Department.


The information I received from my managed care plan states that I have several options when receiving my prescriptions which have to do with a "preferred" list of drugs and a several tiered prescription benefit. What does all that mean?

The preferred list is another name for the plan's formulary. If you receive a drug that is not on this listing, you will be responsible for more out of pocket charges than if the drug was on the preferred list. The tiered prescription plan outlines the different charges for receiving a generic drug, a drug on the preferred list (which can be a brand name) or a brand name drug that is not on the preferred list.