As we announced in last month’s issue of Network Matters, Harvard Pilgrim will be offering a new formulary option for employer groups beginning Jan. 1, 2015. The Value formulary is a closed formulary that will be offered in addition to our current open formulary (the Premium formulary). Harvard Pilgrim’s Value formulary balances cost-effectiveness with benefits, and was developed to include virtually all drug classes, with alternatives available in each class.
The Value formulary will include most generic drugs and single-source brand-name drugs (i.e., those without generic equivalents), while multi-source brand name drugs are excluded. However, there are some exceptions, including the following covered multi-source brand name drugs: Dilantin, Tegretol XR, Synthroid, Levothroid, and Unithroid.
Information for providers and members
Harvard Pilgrim has developed a 2015 Value Formulary Non-Covered Drug List (Abridged) identifying commonly used medications excluded from the Value formulary, as well as their covered alternatives. A complete searchable formulary is also available in the pharmacy section of Harvard Pilgrim’s provider website.
To aid members who are transitioning to the Value formulary, Harvard Pilgrim will mail letters to members who have been prescribed medications in the last year that are not covered in the Value formulary, prior to the effective date of their coverage. This notification will include a list of the non-covered drugs and the covered alternatives, and will encourage the member to contact their physician to discuss which medication is appropriate for them.
For more details on the Value formulary, please refer to this FAQ. If you have any other questions or feedback about the Value formulary, contact Pharmacy Services at firstname.lastname@example.org.