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Employer Health Plans

Employer Plans Formulary / Rx Drug Lists

 

Welborn Health Plans (WHP) provides Prescription benefit coverage locally and nationally though Express Scripts Inc.

Please visit www.express-scripts.com to search for a full listing of participating pharmacy locations.

The Selected Pharmaceutical Lists (SPL) are Preferred Drugs (level 2) that are developed and subject to change at the direction of the Welborn Health Plans Pharmacy & Therapeutics (P&T) Committee. The P&T Committee periodically reviews drugs, or entire classes of drugs, to determine a drug’s status as preferred or non-preferred on a quarterly basis. This determination is made based on the medication’s safety, effectiveness, and cost. Non-Preferred Drugs (level 3) are Covered (subject to Limitations & Exclusions stated in your Certificate of Coverage), but usually require a higher copay.

Selected Pharmaceutical List (SPL)

Alphabetical Listing SPL 2012 (New!)

Therapeutic Class SPL 2012 (New!)

SPL Reference Guide (New!)

Diabetic Supply Resource (New!)

High Deductible Health Plan Members (HDHP)

HDHP Alphabetical Listing SPL 2012 (New!)

HDHP Therapeutic Class Listing SPL 2012 (New!)

SPL Reference Guide (New!)

EVSC Members Only

EVSC's Alphabetical Listing SPL 2012 (EVSC Members Only) (New!)

EVSC's Therapeutic Class SPL 2012 (EVSC Members Only) (New!)

SPL Reference Guide (New!)

EVSC Diabetic Supply Resource (New!)

Specialty Medications

CuraScript – the Express Scripts Specialty Pharmacy – is your source for specialty medications. Express Scripts Specialty Pharmacy, CuraScript, is a full service specialty pharmacy that provides personalized care to each patient. CuraScript provides injectable, oral and infused medications. These complex and costly medications usually require special storage and handling, and may not be readily available at your local drug store. Sometimes these medications have side effects that require monitoring by a trained pharmacist or nurse.
CuraScript focuses on providing these medications, while offering excellent clinical services and support to you and your caregivers. Using your CuraScript specialty pharmacy is easy and can be done with one simple phone call from
you.

When you are given a new prescription for a specialty medication:

■ To begin CuraScript service or to get additional information, call CuraScript toll free at 1.866.848.9870.

■ A representative will contact your doctor to get your prescription.

■ Once approved, the prescription is prepared and checked by a registered pharmacist for accuracy.

■ A representative will call you to schedule the delivery of your medication and supplies to your home or doctor’s office.

■ Your medications are discreetly packaged to protect the medications and your privacy before being shipped at no additional charge.

CuraScript formulary for Welborn Members (Updated 4/1/2012)

CuraScript formulary for EVSC Members (Updated 4/1/2012)

The clinical programs offered through CuraScript are designed to educate and empower all Welborn Health Plans members to adhere to their drug therapy for specific chronic conditions. Click the below link for more information.

CuraScript Clinical Programs (Updated 1/3/2012)

 

"Select Home Delivery" Program (Mail Order)

Convenient Home Delivery Mail Service makes it easier to receive your maintenance medications. You get the same, high-quality prescriptions, dispensed by registered pharmacists, without leaving your home.

"Retail Pharmacy" Drug Program

"Value Added" Program, members can now purchase 90-day supplies of Maintenance Drugs at a participating local retail pharmacy. Please Contact Us for more information on this program and to find a participating pharmacy near you.

Prior Authorization, Quantity Limits, and Step Edits Drug List

 

Utilization Management Requirements (Updated 4/1/2012)

WHP requires that physicians obtain approval before prescribing certain medications. This process helps to ensure that medications are prescribed using well-established medical guidelines. If a member does not fit the criteria that are established for each medication, WHP will work with the physician to find a suitable alternative for our members.

As a part of the quality management program for WHP, quantity limitations have been placed on selected medications. The purpose of this program is to promote appropriate medication use. Amounts that exceed the recommended limitations will not be covered by the WHP Pharmacy Benefit.

If you have any questions with this listing, please call (812) 426-6600