Harvard Pilgrim will be transitioning our Premium formulary from an open to closed formulary, effective Jan. 1, 2018. The Premium formulary will continue to offer coverage for all categories and classes of drugs, except weight loss and cosmetic medications.
While certain multi-source brand name and high cost/low value drugs will not be included on the Premium formulary in 2018, FDA-approved alternatives will be offered for many of these medications. Generic equivalents will be offered in place of brand-name drugs when they are available, and some excluded drugs will have over-the-counter alternatives.
Formulary exception requests
If you feel that there are no clinically appropriate alternatives for a medication that isn’t covered on the Premium formulary, you may request an exception by faxing a completed Formulary Exception Request Form to MedImpact Healthcare Systems, Inc. at 888-807-6643, or by calling MedImpact Customer Service at 800-788-2949.
Member transition period and notification
Between Jan. 1 and March 31, 2018, if a member on the Premium formulary goes to the pharmacy to fill a prescription for a drug that is no longer covered, Harvard Pilgrim will authorize coverage for up to a 30-day supply to accommodate the member’s medication needs and allow for continuation of treatment. The member’s cost sharing for this transition period will be:
- Premium 3-Tier Plan: Tier 1 for generic drugs and Tier 2 for brand-name drugs
- Premium 4-Tier Plan: Tier 2 for generic drugs and Tier 3 for brand-name drugs
In October, Harvard Pilgrim mailed letters to members whose plans currently include the 2017 Premium formulary and who have filled prescriptions for impacted drugs within the last six months, notifying them of the changes to the formulary for 2018. The letters also listed alternative drugs for the members to discuss with their providers.