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You may be able to get a temporary supply
Under certain circumstances, the plan can offer a temporary supply of a drug to
you when your drug is not on the Drug List or when it is restricted in some way.
Doing this gives you time to talk with your doctor about the change in coverage
and figure out what to do.
To be eligible for a temporary supply, you must meet the two requirements below:
- The change to your drug coverage must be one of the following types
of changes:
- The drug you have been taking is no longer on the plan's Drug List
--or --
- The drug you have been taking is now restricted in some way
- You must be in one of the situations described below:
For those members who were in the plan
last year and are not in a long-term
care facility:
- We will cover a temporary supply of your drug one time
only during the first 90 days of the calendar year. This temporary supply
will be for a maximum of a 30-day supply, or less if your prescription
is written for fewer days. The prescription must be filled at a network pharmacy.
For those members who are new to the
plan and are not in a long-term care facility:
- We will cover a temporary supply of your drug one time only during
the first 90 days of your membership in the plan. This temporary supply will be
for a maximum of a 30-day, or less if your prescription is written for fewer days.
The prescription must be filled at a network pharmacy.
For those who are new members and are
residents in a long-term care facility:
- We will cover a temporary supply of your drug during the first
90 days of your membership in the plan. The first supply will be for a maximum of
a 31-day supply, or less if your prescription is written for fewer days. If needed,
we will cover additional refills during your first 90 days in the plan.
For those who have been a member of
the plan for more than 90 days, and are a
resident of a long-term care facility and need a supply right away:
- We will cover one 31-day supply, or less if your prescription is
written for fewer days. This is in addition to the above long-term care transition
supply.
Our plan will cover a temporary 31-day supply of non-formulary drugs (unless the
prescription is written for fewer days) for current members with level of care changes.
To ask for a temporary supply, call Member Services at (318) 361-0900.
During the time when you are getting a temporary supply of a drug, you should talk
with your doctor to decide what to do when your temporary supply runs out. Perhaps
there is a different drug covered by the plan that might work just as well for you.
Or you and your doctor can ask the plan to make an exception for you and cover the
drug in the way you would like it to be covered. The sections below tell you more
about these options.
If you need medical attention or need to fill prescriptions after your coverage
begins, but have not received your ID card, please have your medical provider or
pharmacist call Vantage at 1-318-361-0900, Toll Free 1-888-823-1910 or TTY at 1-866-524-5144
(for the hearing impaired).
Programs To Help Members Use Drugs Safely
We conduct drug use reviews for our members to help make sure that they are getting
safe and appropriate care. These reviews are especially important for members who
have more than one provider who prescribes their drugs.
We do a review each time you fill a prescription. We also review our records on
a regular basis. During these reviews, we look for potential problems such as:
- Possible medication errors.
- Drugs that may not be necessary because you are taking another
drug to treat the same medical condition
- Drugs that may not be safe or appropriate because of your age or
gender.
- Certain combinations of drugs that could harm you if taken at the
same time.
- Prescriptions written for drugs that have ingredients you are allergic
to.
- Possible errors in the amount (dosage) of a drug you are taking.
If we see a possible problem in your use of medications, we will work with your
doctor to
correct the problem.
Programs To Help Members Manage Their Medications
We have programs that can help our members with special situations. For example,
some
members have several complex medical conditions or they may need to take many drugs
at the same time, or they could have very high drug costs.
These programs are voluntary and free to members. A team of pharmacists and doctors
developed the programs for us. The programs can help make sure that our members
are using the drugs that work best to treat their medical conditions and help us
identify possible medication errors.
If we have a program that fits your needs, we will automatically enroll you in the
program and send you information. If you decide not to participate, please notify
us and we will withdraw your participation in the program.
If you would like additional information about the medication therapy management
program, please call Vantage local at 318-361-0900, toll free at 1-888-823-1910
or TTY 1-866-524-5144 (for the hearing impaired).
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