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Charter Health Plan Doctor and Patient Sarasota Memorial Health Care System

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» Active Partners Workshop    Presentation
» Wellness and Prevention    Information

» Primary Care Physicians
» Specialists
» Facilities
» Durable Medical Equipment
» Rehabilitation Services

» Drug Coverage
» Pharmacy Locations

» Claims Appeals Form
» Prescription Drug Claim Form
» Privacy Notice
» Benefits & Coverage (SPD)
» Address/Contact Info Change
» PCP Change


Drug Coverage

As a Charter Health Plan member, your Primary Care Physician (PCP), or a specialist referred by your PCP, may add prescription drugs to your treatment regimen.  To offset your costs for prescription medications, the Charter Health Plan drug benefit will pay up to $1,200 per year.  To receive this benefit you must use these authorized pharmacies only: Davidson Drugs or Target Pharmacies.  Click here for Pharmacy Locations.

Your Charter Health Plan drug benefit covers both retail generic and brand name medications.  Generic drugs have the same active ingredients as brand name drugs, but are less expensive.  Brand name drugs are manufactured by the company named on the application to the Food and Drug Administration (FDA) for new-drug approval.  These companies make the initial investment for product research and development, resulting in higher costs for the brand name drugs.  Your prescription medications are
dispensed at the following rates:

Generic Brand

$15 per prescription or 30 day supply
$40, plus the difference between generic and brand cost, when generic is available,
per 30 day supply

You are encouraged to discuss your prescription drugs with your doctor to see if generics are acceptable substitutes for brand name drugs. This will help keep your cost down for these medications.
Please note the following Charter Health Plan drug benefit restrictions below:

EXCLUDED

• Injectibles (other than insulin,
   Lovenox, and Glucagon)
• Over the counter drugs
• Fertility drugs
• Contraceptives (other than oral)
• Anti-obesity agents
• Smoking deterrents
• Cosmetic agents

• Acne preparations
• Prescription vitamins
• Fluoride preparations
• Growth hormones
• Mifeprex (RU486)
• Gleevec
• Nuvaring
• Botox

• Remicade
• Kineret
• Enbrel
• Humira
• Cox-1 NSAIDS
   (Celebrex, etc.)
• Impotence drugs

REQUIRES PRIOR CHARTER HEALTH PLAN AUTHORIZATION

• Hyperactivity agents
• Multiple sclerosis medications
   (Betaseron, Avonex, etc.)

• Proton pump inhibitors
• Triptans  (Imitrex, Maxalt, etc. – greater than 2   doses per month)

If you have any questions regarding your Charter Health Plan drug benefits, please call the Charter Health Plan Pharmacy Case Manager at 917-8500 (press 1 for member assistance and then choose option 3).

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