The appropriate, cost-efficient use of pharmaceutical therapies can be an effective strategy for improving your health and healthcare expenses. Cleveland Clinic’s EHP Prescription Drug Benefit provides members with medications based on each drug’s effectiveness, safety and value.
To the right are the current pharmacy handbook, formulary and maintenance drug list. These documents are updated quarterly, so be sure to check back for the most current information.
Prior authorization is necessary for coverage of cer tain medications which are listed in the Handbook . The medications on the list may change throughout the year due to FDA approvals of new drugs or new indications are established for previously approved drugs. A Prior Authorization/Formulary Exception Form must be completed or sufficient documentation must be submitted before a case will be reviewed.
Disclaimer: All requests must meet the clinical criteria approved by the Pharmacy and Therapeutics (P&T) Committee before approval is granted. In some cases, approvals will be given a limited authorization date. If a limited authorization is given both the member and the physician will receive documentation on when this authorization will expire. Most requests will be processed within 1-2 business days from the time of receipt. A response will be faxed to the requesting physician, and the member will be informed of the request and the decision via mail.
Statin Medications for Primary Prevention of Cardiovascular Disease: As of January 1st, 2018, under the provisions of the Affordable Care Act mandate regarding cardiovascular disease preventive health services, generic formulary low to moderate dose statins will be covered under the EHP Prescription Drug Benefit at no member out-of-pocket expense within specific coverage guidelines. To begin this process, please have the prescribing provider submit a Statin Formulary Exception Questionnaire to the Employee Health Plan Pharmacy Management Department. All requests must meet the clinical criteria approved by the EHP Pharmacy and Therapeutics (P&T) Committee before approval is granted. Additional information can be found in the EHP Drug Formulary Book (link above).